Screening for inhalational anthrax due to bioterrorism: Evaluating proposed screening protocols

Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA [1, 2]. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria [1] would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of $1900. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with greater than or equal to5 symptoms (but without fever and tachycardia) were screened, charges were $13,325. The Hupert criteria [2] would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of $126,025. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria.