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Reduced Use of Occult Bacteremia Blood Screens by Emergency Medicine Physicians Using Immunization Registry for Children Presenting With Fever Without a Source
Pediatric Emergency Care, 07/11/2012
Zeretzke CM et al. – The state immunization registry is an adjunctive tool to caregiver recall, which can be used by emergency medicine practitioners to confirm completion of the primary conjugate vaccine series before making the decision to perform blood screens for occult bacteremia (OB) in children aged 6 to 24months who present with fever without a source.
Methods- A convenience sample of children 6 to 24months of age presenting to the pediatric emergency department with fever of greater than 39°C without a source was enrolled.
- Physicians were trained to use the SHOTS immunization registry and reviewed the emergency department’s fever protocol.
- A “preregistry” workup plan was documented for each patient based on clinical history, immunization status before accessing SHOTS, and physical examination.
- A “postregistry” workup plan was then documented based on the SHOTS record.
- Demographic and registry data were recorded.
- Preregistry workup plans indicated OB screening blood draws for 100% (n=91; 95% confidence interval [CI], 96–100) of patients with unconfirmed immunization status.
- Of those 91 children, 58% (n=53; 95% CI, 55–61) were documented in SHOTS as having received their primary conjugate vaccine series at ages 2, 4, and 6months.
- Registry access reduced the percentage of screening blood draws from 100% (n=91) to 42% (n=38; 95% CI, 37–53; P<0.001).
