Knowledge about the initial presentation of smallpox among emergency physicians in Washington, DC

To assess the current knowledge of full-time emergency physicians in Washington, DC, regarding the initial diagnosis of smallpox and the initial care of the patient with smallpox.

A written true/false test was prepared based on information accessed from the current Centers for Disease Control and Prevention (CDC) Web site on smallpox. The 20-question test was administered to full-time emergency physicians practicing emergency medicine in all seven adult civilian hospitals in Washington, DC.

The overall response rate was 81% (52 of the 64 eligible full-time emergency physicians). The average score was 59% correct. The facts most likely to be known were 1) that the symptoms of smallpox begin with a two- to four-day prodrome of fever and myalgia (before the appearance of any rash), 2) that no antiviral treatment is of more proven value than vaccination of contacts, and 3) that a person with smallpox may be contagious before any rash appears (average, 90% correct). The facts least likely to be known were 1) that when dealing with a known case of smallpox, fit-tested N95 masks are not needed by treating personnel if they have been vaccinated; 2) that the rash of smallpox begins with 24-48 hours of flat, erythematous macules (not papules or vesicles); and 3) that very typically the rash of smallpox begins in the mouth (average, 22% correct).

Some facts from the current CDC Web site on smallpox are known by a large majority of full-time emergency physicians in Washington, DC, whereas questions based on other facts were answered incorrectly by a majority of the physicians tested.