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Immunization status as determined by patients' hand-held cards vs medical records
A H Fierman1, C M Rosen, L A Legano
1Department of Pediatrics, New York University School of Medicine, New York City, USA.
Insights
Hand-held immunization cards accurately reflect a child's immunization status compared to medical records. These cards are reliable for assessing immunization needs and tracking delays in populations.
Area of Science:
- Pediatrics
- Public Health
- Immunization Practices
Background:
- Accurate tracking of immunization status is crucial for public health.
- Discrepancies between patient records and medical charts can lead to under- or over-vaccination.
- Assessing the reliability of patient-held records is important for efficient healthcare delivery.
Purpose of the Study:
- To evaluate the accuracy of hand-held immunization cards.
- To compare immunization status recorded on patient cards with official medical records.
- To determine the suitability of immunization cards for assessing immunization needs and population-level delay rates.
Main Methods:
- A comparative study was conducted in an urban hospital's pediatric clinic.
- Immunization dates from patient cards and medical records were compared for children aged 4 months to 6 years.
- Agreement on immunization status (up to date, due, or delayed) was analyzed using statistical methods.
Main Results:
- Immunization dates on cards and in medical records were identical in 85% of cases.
- High agreement was observed between cards and records for determining if a child was due for immunization (kappa = 0.77).
- Strong agreement was also found for identifying immunization delays (kappa = 0.79).
Conclusions:
- Hand-held immunization cards serve as a reliable alternative to medical records for assessing immunization status.
- These cards are suitable for evaluating individual immunization needs.
- Immunization cards can be effectively used to determine population-level rates of immunization delay.
Objective:
To determine whether patients' hand-held immunization cards provide accurate assessments of immunization status when compared with their corresponding medical records.
Setting:
Urban hospital emergency department immunization program.
Design:
Comparison of 2 criterion standards.
Patients:
Children aged 4 months to 6 years who presented consecutively with their immunization cards and received routine care in the hospital's pediatric clinic.
Selection:
Of 673 eligible patients seen in the immunization program from November 1992 to October 1993, 140 were randomly selected for comparison of immunization card and medical record immunization dates; in addition, all 123 eligible patients seen between August and October 1994 were selected. Of the total of 263 children, medical records for 257 (98%) were available for review. The dates of diphtheria-tetanus-pertussis, polio, measles-mumps-rubella, and Haemophilus influenzae type b immunization from immunization cards and medical records were recorded, as were patient age, sex, and ethnicity. Immunization card-medical record immunization date pairs were compared. Each immunization card and medical record was categorized as up to date, due for immunization, or delayed 2 months or more for any immunization at the time of the visit.
Results:
In 218 (85%) of 257 cases, the immunization card and medical record immunization dates were identical (McNemar test, P = .63). The immunization card and medical record agreed that patients were due for immunization in 91 cases and agreed that patients were not due for immunization in 138 cases (kappa = 0.77; 95% confidence interval, 0.70-0.85). The immunization card and medical record agreed that patients were delayed for 1 or more immunizations in 51 cases and agreed that patients were not delayed in 187 cases (kappa = 0.79; 95% confidence interval, 0.71-0.88).
Conclusion:
The hand-held immunization card is a suitable alternative to the medical record when the need for immunization is assessed or when rates of immunization delay in populations are determined.