Hupert N, Bearman G, Muslin AI, et al. Accuracy of screening for inhalational anthrax after a bioterrorist attack. Ann Intern Med 2003; 139:337-345.

The researchers identified key symptoms that may help distinguish inhaled anthrax from the flu and other common respiratory conditions in the event of a bioterrorist attack. Results of the study are being used to create the first evidence-based pre-hospital screening protocol designed for response to future anthrax attacks.

The protocol is intended to preserve scarce hospital capacity while ensuring that patients receive appropriate advanced medical care.

By helping emergency management and public health authorities rapidly and accurately identify potential cases and likely noncases, the protocol should help make the best use of scarce resources, they said.

The researchers at Weill Medical College of Cornell University in Ithaca, NY, combined data from the 11 inhaled anthrax cases from the 2001 attacks with historical case reports of 17 additional patients to compare the features of anthrax-related illness with more than 4,000 cases of common viral respiratory tract infections such as the flu. Symptoms such as fever and cough did not reliably discriminate between anthrax and flu or flulike illnesses, but others did prove useful in differentiating.

Neurologic problems such as dizziness and confusion were among the most useful symptoms. Serious gastrointestinal symptoms such as nausea, vomiting, and shortness of breath also were much more common in patients with inhaled anthrax. Sore throat and runny nose were present in some cases of anthrax infection, but those flulike symptoms never occurred in an anthrax patient without at least one of these other symptoms. The researchers suggested the study highlights the importance of considering the complete clinical presentation of inhaled anthrax, as opposed to its component signs and symptoms, in formulating accurate screening protocols. Four of the 11 patients who developed anthrax in 2001 originally were sent home with diagnoses of a viral syndrome, bronchitis, or gastroenteritis.

Shinoda-Tagawa T, Clark DE. Trends in hospitalization after injury: Older women are displacing young men. Injury Prevention 2003; 9:214-219.

Older women have now replaced young men as the leading group requiring hospital admission after injury in the United States, according to this study. "Trauma can no longer be considered a young person’s disease," the authors concluded.

The researchers from the Harvard Injury Control Research Center in Boston examined national hospital discharge data from 1979 to 2000 and categorized the information for each year by age, sex, injury severity, length of hospital stay, and destination after discharge.

The data analysis showed that the percentage of patients admitted to hospital after serious injury almost halved among boys and men younger than 40.

In 1979-83, they accounted for 41%. By 1996-2000, they accounted for 26%. By contrast, the proportion of patients age 75 and older more than doubled over the same time frame. Only a fraction of this difference is attributable to the changing demographics, the authors said.

Hip fractures accounted for half of all hospital admissions for injury among women age 75 and older and about 40% of those among men the same age.