Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm.
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 compar...
| Publicado en: | CHEST Vol. 131; no. 2; pp. 489 - 497 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
American College of Chest Physicians
Feb2007
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106008581&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106008581 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00123692 1G4 jtl: CHEST issn: 00123692 maglogo: N pubinfo: dt: Feb2007 vid: 131 iid: 2 pid: 2556 pub: American College of Chest Physicians place: Glenview, Illinois artinfo: ui: 106008581 NLM17296652 2009515912 10.1378/chest.06-1687 NLM17296652 106008581 ppf: 489 ppct: 8 formats: tig: atl: Discriminating inhalational anthrax from community-acquired pneumonia using chest radiograph findings and a clinical algorithm. aug: au: Kyriacou DN Yarnold PR Stein AC Schmitt BP Soltysik RC Nelson RR Frerichs RR Noskin GA Belknap SM Bennett CL Kyriacou, Demetrios N Yarnold, Paul R Stein, Adam C Schmitt, Brian P Soltysik, Robert C Nelson, Regina R Frerichs, Ralph R Noskin, Gary A Belknap, Steven M Bennett, Charles L affil: Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 259 Erie St, Suite 100, Chicago, IL 60611, USA sug: subj: Algorithms Anthrax Radiography Community-Acquired Infections Radiography Pneumonia Radiography Adolescence Adult Aged Aged, 80 and Over Case Control Studies Diagnosis, Differential Female Hematocrit Male Middle Age Human Adolescent: 13-18 years Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: 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. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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