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.”

[snip

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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Canada
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India
•  8 new deaths confirmed and 185 ‘fresh’ cases nationwide (Link)
•  Jodhpur confirms 3rd death this week (Link)

Indonesia
•  Training exercises to prep for H5N1 contingencies (Link)

United Kingdom
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United States
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•  CO: list of districts closing this week for flu absentee levels (Link)
•  DE: Del. could have bed shortage during flu outbreak (Link)
•  FL: 10 mos. baby girl died of H1N1, had ‘underlying’ health issues (Link)
•  IA: Low on vaccine, Polk cancels some seasonal flu shot clinics (Link)
•  IA: Des Moines confirmed 4th death  (Link)
•  ID: Idaho teen dies from H1N1 (Link)
•  IN: Illness prompts closure of Indianapolis school (Link)
•  MN: Local schools hit hard by flu-like symptoms (Link)
•  MS: 8th swine flu death in Mississippi  (Link)
•  MT: Montana schools ‘hit hard’ in Butte, Anaconda-Deer Lodge, Granite and Beaverhead counties (Link)
•  NC: La Grange Elementary student out with flu  (Link)
•  OR: Flu concerns force hospitals to limit visitors (Link)
•  PA: High school to close Th/Fri for ‘swine flu scare’, 363 out ‘sick’ (Link)
•  SC: swine flu surges at Clemson  (Link)
•  TN: Crossville doctor thinks schools should close for H1N1 (Link)
•  TN: Children’s Hospital sees first pediatric H1N1 death (Link)
•  TX: El Paso To Receive Almost 600,000 Vaccine Doses (Link)
•  TX: Corpus Christi has 3rd death in week (Link)
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•  TX: confirmation that Harris County jail inmate died of H1N1 (Link)
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General
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•  New poll (Link)

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