Immunization status as determined by patients' hand-held cards vs medical records
A. H. Fierman, C. M. Rosen, L. A. Legano, S. W. Lim, A. L. Mendelsohn and B. P. Dreyer
Department of Pediatrics, New York University School of Medicine, New York City, USA.
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.
