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Decision rules for predicting vaccination status of preschool-age emergency department patients
S G Humiston1, L E Rodewald, P G Szilagyi
1Department of Pediatrics, University of Rochester, New York.
Insights
Identifying undervaccinated children in emergency departments (ED) is challenging. Developed decision rules showed limitations in accurately predicting which preschool-aged patients require vaccination, suggesting a need for improved assessment methods.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Undervaccination remains a significant public health concern, particularly among pediatric populations accessing emergency care.
- Emergency departments (ED) present a potential, yet largely untapped, venue for identifying and addressing vaccination gaps in children.
- Existing methods for assessing vaccination status in the ED setting are often insufficient.
Purpose of the Study:
- To develop and validate decision rules for predicting undervaccination in preschool-aged children presenting to emergency departments.
- To identify key demographic and healthcare utilization factors associated with undervaccination in this population.
Main Methods:
- Recursive partitioning was used to create predictive decision rules based on data from 602 ED patients (4-48 months).
- Data collected included demographics, vaccination status, health status, healthcare utilization, and parental/physician reports.
- Rules were prospectively validated on a separate cohort of 1832 ED patients (6-36 months).
Main Results:
- Factors associated with undervaccination included delayed vaccination, lack of insurance, time since last primary care visit, household size, and maternal age.
- Eight decision rules were generated with varying sensitivity (0.27-0.87) and specificity (0.54-0.98).
- No single rule achieved both high sensitivity and high specificity, and performance was consistent in the validation sample.
Conclusions:
- Accurately identifying undervaccinated children using information readily available during an ED visit is inherently difficult.
- Current decision rules are insufficient for efficient intervention, highlighting the need for improved vaccination status assessment strategies in emergency settings.
Abstract:
We produced and tested rules to predict undervaccination among preschool-age emergency department (ED) patients. Data were gathered on demographics, vaccination status, health status, and health care utilization from parents, ED physicians, and ED charts at an urban teaching hospital in Rochester, N.Y. Primary care charts were reviewed to verify vaccination status. Using recursive partitioning, we developed decision rules to predict undervaccination. Decision rules were developed on a sample of 602 ED patients 4 to 48 months of age and then prospectively tested on 1832 ED patients aged 6 to 36 months. Factors associated with undervaccination for any vaccine included parental report of vaccination delay (odds ratio = 8.1; p < 0.001), inability to report the receipt of the appropriate number of vaccines (odds ratio = 4.5; p < 0.001), lack of health insurance (odds ratio = 3.6, p < 0.001), elapsed time since the last visit to primary care provider (p < 0.001), household size (p < 0.001), and maternal age (p < 0.01). Eight decision rules were produced that varied in their number of questions (one to six), sensitivity (0.27 to 0.87), and specificity (0.54 to 0.98). No single rule was both highly sensitive and highly specific. The rules' sensitivities and specificities were similar for the validation sample of 1832 patients. Thus a decision rule could not be produced that was both sensitive and specific. Identification of undervaccinated children by means of information available at an ED visit is inherently difficult. Interventions in the ED may be inefficient unless better methods of assessing vaccination status can be developed.