October 7, 2009 (Boston, Massachusetts) – Emergency department physicians had difficulty identifying influenza victims after a mass outbreak in a simulated pandemic influenza drill in a study presented here at the American College of Emergency Physicians 2009 Scientific Assembly.

Using a screening algorithm called the Mass Screening, Triage and Isolation (MSTI) tool, the doctors failed to recognize influenza in 46% of children aged 5 years and younger. They also separated children from their parents for treatment when their symptoms differed, despite existing recommendations to the contrary, announced Baruch S. Fertel, MD, from the University of Cincinnati in Ohio.

“The most important thing we learned from this simulation exercise was that it is easy to miss the diagnosis in children,” said Dr. Fertel in an interview with Medscape Emergency Medicine. The study was conducted when he was at SUNY Downstate Medical Center in Brooklyn, New York. “Even experienced clinicians who see a lot of patients often have trouble identifying children with influenza-like illnesses.”


The investigators found a significant correlation between decreasing age and difficulty recognizing influenza symptoms. In addition to missing the diagnosis in almost half of the youngest children, they misdiagnosed 23% of the children aged 13 to 17 years and 33% of the children aged 6 to 12 years, saying they did not meet the criteria for influenza. They also found that of the 26 families who had a child with differing symptoms, 14 (54%) received a discordant disposition that resulted in the separation of children from their parents for treatment.

“Not only did this cause additional trauma to the children, it was also labor-intensive, as additional staff were needed to chaperone unaccompanied minors,” Dr. Fertel said.

“Part of pandemic and disaster preparedness is getting ready for the unknown,” he pointed out. “The best way we can prepare for an unknown, especially in disaster medicine, is by conducting drills and exercises. We believe that our drill was unique because it is hard to get kids [to act as patients], but we got a lot of kids to participate in our study. That is what gave it a more realistic scenario.”

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