Zeretzke Cristina M, McIntosh Mark S, Kalynych Colleen J, Wylie Todd, Lott Michelle, Wood David
Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
Pediatr Emerg Care. 2012 Jul;28(7):640-5. doi: 10.1097/PEC.0b013e31825cfd3e.
This study examined whether utilization of the Florida State Health Online Tracking System (SHOTS) immunization registry to determine Haemophilus influenzae type B and heptavalent pneumococcal conjugate (PCV7) vaccine status impacts the protocolized decision to perform a screening blood draw for occult bacteremia (OB) in young children.
A convenience sample of children 6 to 24 months of age presenting to the pediatric emergency department with fever of greater than 39°C without a source was enrolled. Physicians were trained to use the SHOTS immunization registry and reviewed the emergency department's fever protocol. A "preregistry" workup plan was documented for each patient based on clinical history, immunization status before accessing SHOTS, and physical examination. A "postregistry" workup plan was then documented based on the SHOTS record. Demographic and registry data were recorded.
Preregistry workup plans indicated OB screening blood draws for 100% (n = 91; 95% confidence interval [CI], 96-100) of patients with unconfirmed immunization status. Of those 91 children, 58% (n = 53; 95% CI, 55-61) were documented in SHOTS as having received their primary conjugate vaccine series at ages 2, 4, and 6 months. Registry access reduced the percentage of screening blood draws from 100% (n = 91) to 42% (n = 38; 95% CI, 37-53; P < 0.001).
The state immunization registry is an adjunctive tool to caregiver recall, which can be used by emergency medicine practitioners to confirm completion of the primary conjugate vaccine series before making the decision to perform blood screens for OB in children aged 6 to 24 months who present with fever without a source.
本研究探讨利用佛罗里达州健康在线追踪系统（SHOTS）免疫登记系统来确定B型流感嗜血杆菌和七价肺炎球菌结合疫苗（PCV7）接种状态，是否会影响对幼儿进行隐匿性菌血症（OB）筛查血检的标准化决策。
纳入6至24个月大、因体温高于39°C且无明确病因就诊于儿科急诊科的儿童作为便利样本。医生接受了使用SHOTS免疫登记系统的培训，并复习了急诊科的发热诊疗方案。根据临床病史、在查询SHOTS之前的免疫接种状态和体格检查，为每位患者记录一份“登记前”检查计划。然后根据SHOTS记录记录一份“登记后”检查计划。记录人口统计学和登记数据。
登记前检查计划显示，100%（n = 91；95%置信区间[CI]，96 - 100）未确认免疫接种状态的患者需进行OB筛查血检。在这91名儿童中，58%（n = 53；95% CI，55 - 61）在SHOTS中记录为已在2、4和6个月龄时接种了主要的结合疫苗系列。查询登记系统后，筛查血检的比例从100%（n = 91）降至42%（n = 38；95% CI，37 - 53；P < 0.001）。
国家免疫登记系统是辅助照顾者回忆的工具，急诊医学从业者可利用该系统在决定对6至24个月龄、因发热且无明确病因就诊的儿童进行OB血检筛查之前，确认其是否完成了主要的结合疫苗系列接种。
