Bell L M, Lopez N I, Pinto-Martin J, Casey R, Gill F M
Children's Hospital of Philadelphia, PA 19104.
Pediatrics. 1994 Jan;93(1):99-103.
To determine whether the use of an urban pediatric emergency department (ED) to immunize pre-school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life.
A retrospective cohort study of two groups: (1) 100 consecutive children (ED group) enrolled at one of two hospital-affiliated primary care clinics were chosen from the ED patient logs if their second birthday occurred in the 12 months prior to November 1990; and (2) 91 age-matched control children (control group) were chosen at random from the same hospital-affiliated clinics' enrollment logs without regard to ED use. The health care provided during the first 2 years of life for each group was compared.
The mean number of visits to the ED in the first 2 years of life by the ED group was significantly greater than that of the control group (2.9 [SD] +/- 2.5 vs 1.1 +/- 1.4; P < .001) during the first 2 years of life. In 67% of ED visits, children would have been well enough to receive a vaccination. Both groups had similar types and numbers of visits to the primary clinics. For example, the ED group had 10 +/- 5 visits by age 2 years compared with the control group, which had 9 +/- 4 visits. There was no significant difference in actual immunization percentages achieved in the clinic, with 62% of the ED group having received four diphtheria, pertussis, and tetanus vaccinations; three oral poliovirus vaccinations; and one measles, mumps, and rubella vaccination by age 2 compared with 69% of control children. There were more missed vaccination opportunities during clinic visits in the ED group (7.4 vs 4.6 per 100 clinic visits; P < .01). If immunizations were offered in the ED to those children who needed them, immunization percentages would have been increased an average of 20% compared with percentages achieved in the clinic alone.
Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.
确定利用城市儿科急诊科（ED）为学龄前儿童进行免疫接种是否会使两岁末时完全接种疫苗的儿童百分比得到提高。
一项对两组进行的回顾性队列研究：（1）从两家医院附属基层医疗诊所之一登记的100名连续儿童（急诊科组），如果他们的第二个生日发生在1990年11月前的12个月内，则从急诊科患者记录中选取；（2）91名年龄匹配的对照儿童（对照组）从同一家医院附属诊所的登记记录中随机选取，不考虑是否使用过急诊科。比较了两组儿童在生命最初两年所接受的医疗保健情况。
在生命的头两年，急诊科组儿童到急诊科就诊的平均次数显著多于对照组（2.9[标准差]±2.5次对1.1±1.4次；P<.001）。在67%的急诊科就诊中，儿童的健康状况足以接受疫苗接种。两组到基层诊所就诊的类型和次数相似。例如，急诊科组在两岁时就诊10±5次，而对照组就诊9±4次。两组在诊所实际实现的免疫接种百分比没有显著差异，到两岁时，急诊科组62%的儿童接受了四次白喉、百日咳和破伤风疫苗接种；三次口服脊髓灰质炎疫苗接种；一次麻疹、腮腺炎和风疹疫苗接种，而对照儿童为69%。急诊科组在诊所就诊期间错过的疫苗接种机会更多（每100次诊所就诊7.4次对4.6次；P<.01）。如果在急诊科为那些需要的儿童提供免疫接种，与仅在诊所实现的百分比相比，免疫接种百分比平均将提高20%。
在急诊科进行常规疫苗接种将显著提高两家医院附属诊所登记儿童的免疫接种百分比。急诊科与医院附属诊所之间的紧密联系与协调可能会改善使用急诊科的城市儿童的预防性医疗保健。
