Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm.

Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Research Abstract Details 

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Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Abstract Text:

Demetrios N Kyriacou,Paul R Yarnold,Adam C Stein,Brian P Schmitt,Robert C Soltysik,Regina R Nelson,Ralph R Frerichs,Gary A Noskin,Steven M Belknap,Charles L Bennett,

BACKGROUND: Limiting the effects of a large-scale bioterrorist anthrax attack will require rapid and accurate detection of the earliest victims. We undertook this study to improve physicians' ability to rapidly detect inhalational anthrax victims. METHODS: We conducted a case-control study to compare chest radiograph findings from 47 patients from historical inhalational anthrax cases and 188 community-acquired pneumonia control subjects. We then used classification tree analyses to derive an algorithm of chest radiograph findings and clinical characteristics that accurately and explicitly discriminated between inhalational anthrax and community-acquired pneumonia. RESULTS: Twenty-two of the 47 patients from historical inhalational anthrax cases (46.8%) had reported chest radiograph findings. All 22 case patients (100%) had mediastinal widening, pleural effusion, or both. However, 16 case patients (72.7%) also had infiltrates. In comparison, all 188 community-acquired control subjects had reported chest radiographs. Of these, 127 control subjects (67.6%) had infiltrates, 43 control subjects (22.9%) had pleural effusions, and 15 control subjects (8.0%) had mediastinal widening. A derived algorithm with three predictor variables (chest radiograph finding of mediastinal widening, altered mental status, and elevated hematocrit) is 100% sensitive (95% confidence interval [CI], 73.5 to 100) and 98.3% specific (95% CI, 95.1 to 99.6). The derivation process used 12 patients with inhalational anthrax and 177 control subjects with community-acquired pneumonia who had information available for all three variables. CONCLUSIONS: There are significant chest radiograph differences between inhalational anthrax and community-acquired pneumonia, but none of the chest radiograph findings are both highly sensitive and highly specific. The derived clinical algorithm can improve physicians' ability to discriminate inhalational anthrax from community-acquired pneumonia, but its utility is limited to previously healthy individuals and its accuracy may be limited by missing values.

Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Publishing Authors By Initials

DN Kyriacou,PR Yarnold,AC Stein,BP Schmitt,RC Soltysik,RR Nelson,RR Frerichs,GA Noskin,SM Belknap,CL Bennett,

For similar respiratory tract diseases: lung diseases: pneumonia research abstracts see: respiratory tract diseases: lung diseases: pneumonia research

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Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Journal Published:

PUBLICATION TYPE: Research Support, U.S. Gov't,

Journal: Chest

VOLUME: 131

Page Numbers: 489-96

Journal Abbreviation: Chest

ISSN: 0012-3692

DAY: 3

MONTH: Feb

YEAR: 2007

Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Information

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LANGUAGE: eng

NlmUniqueID: 231335

Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. Keywords Mesh Terms:

KEYWORDS: Pneumonia

MESH TERMS: radiography

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Grant and Affiliation Information for Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm.

AFFILIATION: Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 259 Erie St, Suite 100, Chicago, IL 60611, USA. dkyriacou@aol.com

Country: United States

AGENCY: United States NCI

GRANT: 1R01CA 102713-01

ACRONYM: CA

MEDLINETA: Chest

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