Rodewald L E, Szilagyi P G, Humiston S G, Raubertas R F, Roghmann K J, Doane C B, Cove L A, Hall C B
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY.
Pediatrics. 1993 Mar;91(3):605-11.
The purpose of this study was to determine: (1) whether preschool-age patients who utilize the emergency department (ED) are undervaccinated compared with patients having the same primary care provider and (2) whether reducing missed vaccination opportunities in the primary care office can potentially reduce the differences in undervaccination between the groups. This retrospective cohort study involved two groups: 583 ED patients, aged 4 to 48 months, who had primary care providers; and 583 control subjects randomly selected from primary care sites and matched according to date of birth and primary care site. The major outcome variable was the point prevalence of undervaccination, defined as more than 60 days past due for a vaccine at the time of the ED visit, and for control subjects, at the time of their matched patient's ED visit. Demographic variables, vaccination history, presence of chronic illness, and office utilization history were abstracted from office charts. The mean age of all patients was 20.0 months. Emergency department patients were more likely to be boys (61% vs 50%) and had more chronic illness, but did not differ racially from those in the control group. Primary care sites included a hospital-based clinic (n = 137), neighborhood health centers (n = 172), and private practices (n = 274). The undervaccination rates by primary provider type were for (1) hospital clinic ED patients 21.1%, control subjects 19.7%; (2) neighborhood health center ED patients 29.1%, control subjects 22.7%; and (3) private practice ED patients 26.6%, control subjects 14.9%. Overall, the odds ratio of ED patients' being undervaccinated compared with control subjects was 1.8 (95% confidence interval 1.3 to 2.5).(ABSTRACT TRUNCATED AT 250 WORDS)
（1）与有相同初级保健提供者的患者相比，使用急诊科（ED）的学龄前患者疫苗接种不足情况；（2）减少初级保健诊所错过的疫苗接种机会是否有可能缩小两组间疫苗接种不足的差异。这项回顾性队列研究涉及两组：583名年龄在4至48个月、有初级保健提供者的急诊科患者；以及从初级保健机构随机选取的583名对照对象，这些对照对象根据出生日期和初级保健机构进行匹配。主要结局变量是疫苗接种不足的时点患病率，定义为在急诊科就诊时疫苗逾期超过60天，对于对照对象，则是在其匹配患者急诊科就诊时。从病历中提取人口统计学变量、疫苗接种史、慢性病情况和门诊利用史。所有患者的平均年龄为20.0个月。急诊科患者更可能是男孩（61%对50%），且有更多慢性病，但在种族方面与对照组无差异。初级保健机构包括一家医院诊所（n = 137）、社区健康中心（n = 172）和私人诊所（n = 274）。按初级提供者类型划分的疫苗接种不足率为：（1）医院诊所急诊科患者21.1%，对照对象19.7%；（2）社区健康中心急诊科患者29.1%，对照对象22.7%；（3）私人诊所急诊科患者26.6%，对照对象14.9%。总体而言，与对照对象相比，急诊科患者疫苗接种不足的优势比为1.8（95%置信区间1.3至2.5）。（摘要截断于250字）
