University of Florida in Gainesville, Department of Emergency Medicine, Gainesville, Florida.
University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas.
West J Emerg Med. 2020 Aug 21;21(5):1140-1146. doi: 10.5811/westjem.2020.6.46582.
Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS - State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED).
We conducted a retrospective review of all patients less than 18 years old who received ED tetanus prophylaxis at two separate sites between January 2011-May 2015. The Florida SHOTS database was accessed to determine vaccination status for each patient in the study group at the time of the encounter. We compared vaccination status for each patient, as documented in the electronic health record (EHR), with Florida SHOTS data to determine whether tetanus prophylaxis was indicated. The proportion of patients receiving tetanus prophylaxis in the ED, who were subsequently identified as up to date with tetanus vaccination per Florida SHOTS, was determined.
We identified 743 patients who received ED tetanus prophylaxis. Forty-three (6%) were listed as "up to date" on the EHR and 656 (93%) were listed as "not up to date." In comparison, 209 (30%) of the study group were identified as "up to date" via Florida SHOTS, and 477 (70%) were not. We accessed the Florida SHOTS record retrospectively to determine whether the vaccine was required. It was determined that 174 (25%) of the patients received tetanus prophylaxis unnecessarily as they were already up to date per Florida SHOTS documentation.
Twenty-five percent of patients vaccinated for tetanus in the ED could have been spared if Florida SHOTS data had been used by providers at the time of the encounter. Access to Florida SHOTS provides valuable information regarding vaccination status that impacts patient care and resource utilization in the ED.
对于管理破伤风易感伤口的急诊医师，破伤风疫苗接种状况是一个重要的考虑因素。医师必须识别出高危患者，但接种史通常未知且缺乏文件记录。本研究的目的是确定在线免疫登记系统（佛罗里达州 SHOTS-州健康在线跟踪系统）对在急诊科管理的儿科患者进行适当破伤风预防的潜在影响。
我们对 2011 年 1 月至 2015 年 5 月期间在两个不同地点接受急诊破伤风预防的所有 18 岁以下患者进行了回顾性研究。我们访问了佛罗里达州 SHOTS 数据库，以确定研究组中每位患者在就诊时的接种状况。我们将每位患者的接种状况与电子健康记录（EHR）中的记录进行比较，以确定是否需要破伤风预防。确定在急诊科接受破伤风预防的患者中，有多少人根据佛罗里达州 SHOTS 的数据被认为是最新的破伤风疫苗接种者。
我们确定了 743 例接受急诊破伤风预防的患者。43 例（6%）在 EHR 中被列为“最新”，656 例（93%）被列为“未更新”。相比之下，研究组中有 209 例（30%）通过佛罗里达州 SHOTS 被识别为“最新”，477 例（70%）未被识别。我们回顾性地访问了佛罗里达州 SHOTS 的记录，以确定是否需要接种疫苗。根据佛罗里达州 SHOTS 的文件记录，确定 174 例（25%）患者接受了不必要的破伤风预防，因为他们已经按照佛罗里达州 SHOTS 的规定更新了疫苗。
如果在就诊时提供者使用了佛罗里达州 SHOTS 数据，那么在急诊科接受破伤风预防的 25%的患者可能可以避免。访问佛罗里达州 SHOTS 提供了有关疫苗接种状况的有价值信息，这会影响急诊科的患者护理和资源利用。
