Emergency Physicians Using an Online Immunization Registry Perform Fewer Blood Screens for Occult Bacteremia on Children Aged 6-24 Months Who Present to Ed with Fever Without a Source

Objectives  This study examined whether utilization of the Florida State Health Online Tracking System (SHOTS) immunization registry to determine  Haemophilus influenzae  type B and heptavalent pneumococcal conjugate (PCV7) vaccine status impacts the protocolized decision to perform a screening blood draw for occult bacteremia (OB) in young children.

Methods  A convenience sample of children 6 to 24 months 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.

Results  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 6 months. Registry access reduced the percentage of screening blood draws from 100% (n = 91) to 42% (n = 38; 95% CI, 37–53;  P  < 0.001).

Conclusions  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 OB in children aged 6 to 24 months who present with fever without a source.