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Syndromic Surveillance for Bioterrorism-related Inhalation Anthrax in an Emergency Department Population

Soulakis, Nicholas (2013) Syndromic Surveillance for Bioterrorism-related Inhalation Anthrax in an Emergency Department Population. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Objective: To utilize clinical data from emergency department admissions and published clinical case reports from the 2001 bioterrorism-related inhalation anthrax (IA) outbreak to develop a detection algorithm for syndromic surveillance.

Methods: A comprehensive review of case reports and medical charts was undertaken to identify clinical characteristics of IA. Eleven historical cases were compared to 160 patients meeting a syndromic case definition based on acute respiratory failure and the presence of mediastinal widening or lymphadenopathy on a chest radiograph.

Results: The majority of syndromic group patients admitted were due to motor vehicle accident (52%), followed by fall (10%), or other causes (4%). Positive culture for a gram positive rod was the most predictive feature for anthrax cases. Among signs and symptoms, myalgias, fatigue, sweats, nausea, headache, cough, confusion, fever, and chest pain were found to best discriminate between IA and syndromic patients. When radiological findings were examined, consolidation and pleural effusions were both significantly higher among IA patients. A four step algorithm was devised based on combinations of the most accurate clinical features and the availability of data during the course of typical patient care. The sensitivity (91%) and specificity (96%) of the algorithm were found to be high.

Conclusions: Surveillance based on late stage findings of IA can be used by clinicians to identify high risk patients in the Emergency Department using a simple decision tree.

Implications for public health: Monitoring pre-diagnostic indicators of IA can provide enough credible evidence to initiate an epidemiological investigation leading to earlier outbreak detection and more effective public health response.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Soulakis, Nicholasnicholas.soulakis@northwestern.edu0000-0002-7666-8977
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSonger, Thomastjs@pitt.eduTJS
Committee MemberLaPorte, Ronaldlaporte@pitt.eduLAPORTE
Committee MemberAnderson, Stewartsja@pitt.eduSJA
Date: 8 February 2013
Date Type: Completion
Defense Date: 20 August 2012
Approval Date: 8 February 2013
Submission Date: 4 December 2012
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 225
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: epidemiology syndromic surveillance anthrax
Date Deposited: 08 Feb 2013 16:18
Last Modified: 15 Nov 2016 14:08


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