Unexplained Deaths in Connecticut, 2002-2003: Failure to Consider Category A Bioterrorism Agents in Differential Diagnoses
Unexplained Deaths in Connecticut, 2002-2003: Failure to Consider Category A Bioterrorism Agents in Differential Diagnoses
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DOI：
10.1097/dmp.0b013e318161315b
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发表时间：
2008-06-01
影响因子：
2.7
通讯作者：
Sofair, Andre N.
中科院分区：
文献类型：
--
作者：
Palumbo, John P.;Meek, James I.;Sofair, Andre N.
背景：医院和急诊科临床医生对生物恐怖主义相关感染的识别可能是生物恐怖袭击的第一道防线。方法：我们利用康涅狄格州的死亡证明和医院图表信息，确定了与炭疽、土拉菌病、天花和肉毒杆菌中毒的临床表现一致的不明原因的感染性死亡。建立了最低检查标准来评估诊断测试的完整性。结果：4558例不明原因感染性死亡中，133例（2.9%）与炭疽热相符，6例（0.13%）与土拉菌病相符。没有一个与天花或肉毒杆菌中毒相符。没有死亡病例在鉴别诊断中有炭疽或兔热病，也没有进行疾病特异性血清学检查。只有53%的病例符合最低检查标准。结论：除炭疽外，康涅狄格州少数原因不明的死亡可能是所研究的生物恐怖主义制剂的结果。在47%可能是炭疽热导致的死亡病例中，很可能没有被诊断出来。2004年，康涅狄格的医生在有意或无意地诊断炭疽或兔热病的初始病例方面没有做好充分的准备。需要更有效的临床医生教育和监测策略，以尽量减少在生物恐怖袭击中遗漏最初病例的可能性。（灾难医学和公共卫生准备。2008;2:87-94）
Background: Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.Methods: We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing.Results: Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases.Conclusions: Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack. (Disaster Med Public Health Preparedness. 2008;2:87-94)