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Structured guidelines for the use of influenza vaccine among children with chronic pulmonary disorders
G F Hayden1, H Frayha, H Kattan
1Department of Pediatrics, University of Virginia Medical Center, Charlottesville 22908, USA.
Insights
Structured guidelines improved physician agreement on influenza vaccination for children with chronic pulmonary diseases. However, even when vaccination was recommended, uptake remained low, highlighting a need for further research and improved vaccination strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Annual influenza vaccination is recommended for children aged 6 months and older with chronic pulmonary diseases.
- Studies indicate that a significant number of high-risk children do not receive influenza vaccinations.
- Physician agreement on vaccination indications for pediatric patients with pulmonary conditions can be inconsistent.
Purpose of the Study:
- To evaluate if structured guidelines enhance physician consensus regarding influenza vaccination for children with pulmonary disorders.
- To assess the impact of specific guidelines on interrater agreement among pediatricians.
Main Methods:
- A pilot study involving the review of 73 children's hospital records from pulmonary, allergy, and high-risk neonatology clinics.
- Four pediatricians independently assessed vaccination necessity.
- Two reviewers utilized specific guidelines, while the other two relied on clinical judgment.
Main Results:
- Higher interrater agreement was observed between reviewers using structured guidelines (overall agreement, 0.89; kappa = 0.73) compared to those using clinical judgment (overall agreement, 0.68; kappa = 0.31).
- Among 34 children deemed advisable for vaccination by all four reviewers, only 13 (38%) had actually been vaccinated.
- The guidelines demonstrated improved consistency in identifying children who warrant influenza vaccination.
Conclusions:
- Structured guidelines can improve physician agreement on influenza vaccination indications for children with chronic pulmonary diseases.
- Despite agreement on advisability, vaccination rates remain suboptimal, suggesting barriers beyond physician recommendation.
- Further research is needed to define influenza risks in specific pediatric lung disorders, and these guidelines offer a foundation for identifying at-risk children.
Abstract:
National committees recommend annual influenza vaccination for children > or = 6 months of age with chronic pulmonary diseases, but several studies have suggested that many high risk children do not receive the vaccine. The purpose of this pilot study was to determine whether the use of structured guidelines for which pulmonary disorders warrant influenza vaccination would increase agreement among physicians on whether specific children should be vaccinated. Hospital records of 73 children with an outpatient appointment during the previous month in the pulmonary, allergy or high risk neonatology clinics were reviewed independently by 4 pediatricians. Two reviewers used a set of specific guidelines in deciding whether influenza vaccination was indicated, whereas the other 2 used unspecified clinical judgment. Interrater agreement concerning the advisability of vaccination was higher between the reviewers using the guidelines (overall agreement, 0.89; kappa = 0.73) than between the reviewers using clinical judgment (overall agreement, 0.68; kappa = 0.31). Even among the 34 children for whom all 4 reviewers thought the vaccine advisable, only 13 (38%) had been vaccinated. Studies to define the risk of severe influenza among children with specific lung disorders are needed, but these guidelines can serve as a starting point for the identification of children who deserve individual consideration for annual influenza vaccination.
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