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Bioterrorism-related inhalational anthrax: can extrapolated adult guidelines be applied to a pediatric population?
Rick C Place1, Dan Hanfling, John M Howell
1Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA. linsonplace@aol.com
Insights
Current screening guidelines for inhalational anthrax are unreliable for children. Pediatric patients, especially infants, present with nonspecific symptoms, making early identification challenging.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatric Emergency Medicine
Background:
- The 2001 anthrax attacks spurred extensive research, yet pediatric-specific management remains under-explored.
- Limited data exists on the efficacy of existing anthrax screening guidelines for pediatric populations.
Purpose of the Study:
- To evaluate the applicability of current anthrax screening guidelines for identifying pediatric cases.
- To analyze the symptom complexes of pediatric patients presenting to the emergency department post-anthrax exposure.
Main Methods:
- Retrospective review of emergency department records for adult and pediatric patients (up to 21 years).
- Application of established screening algorithms (Mayer et al., Hupert et al.) based on fever, tachycardia, and compatible symptoms.
- Assessment of guideline utility for identifying potentially infected children.
Main Results:
- Of 767 pediatric patients, 312 met review criteria; no pediatric patient presented with five or more symptoms.
- Twelve children (3.9%) had four symptoms; five lacked fever or tachycardia.
- Pediatric patients, particularly infants, exhibited nonspecific symptoms like fever, vomiting, cough, and dyspnea.
Conclusions:
- Existing screening guidelines are likely ineffective for inhalational anthrax in children.
- Children's limited ability to communicate symptoms hinders the reliability of current screening tools.
Objective:
Since the 2001 anthrax attacks, an extensive body of literature has evolved, but there has been a limited focus on the management of pediatric-specific issues. We looked at the symptom complexes of all pediatric patients presenting to the emergency department of our hospital during this period and examined whether their presentations would likely allow current guidelines to be used as potential screening criteria to identify children infected with anthrax.
Methods:
We retrospectively reviewed emergency department records of all adult and pediatric patients (up to the age of 21 years) at Inova Fairfax Hospital during this time, when a large, and at the time ill-defined, group in the Washington, DC, metropolitan area was at risk for pulmonary anthrax. Two cases of anthrax infection were identified at this hospital in exposed adult postal workers. Screening algorithms (described by Mayer et al. and Hupert et al.) were applied to adult and pediatric patients with the presence of fever (38 degrees C), tachycardia, or other symptoms compatible with pulmonary anthrax. Specifically, the usefulness of these guidelines as potential screening tools to identify possibly infected children was examined.
Results:
Of 767 pediatric patients seen in the emergency department during the study period, 312 met criteria for review (41%; 95% CI: 37-44%). Four adult patients (0.4%; 95% CI: 0.1-0.9%) had at least five clinical symptoms, fever, and tachycardia; two of them had inhalational anthrax. No pediatric patient presented with five or more clinical symptoms. Twelve children (3.9%; 95% CI: 2-6.6%) presented with four clinical symptoms; five of the 12 had neither fever nor tachycardia. Children, particularly infants and toddlers, presented with nonspecific symptom complexes primarily limited to fever, vomiting, cough, and trouble breathing.
Conclusions:
Existing guidelines are likely to be unreliable as a screening tool for inhalational anthrax in children, largely because of the children's inability to adequately communicate a suggestive symptom complex.
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