title: Potential impact of linking an emergency department and hospital-affiliated clinics to immunize pre-school-age children.
abstract: OBJECTIVE
  To determine whether the use of an urban pediatric emergency department (ED) to immunize pre-school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life.
  
  
  METHODS
  A retrospective cohort study of two groups: (1) 100 consecutive children (ED group) enrolled at one of two hospital-affiliated primary care clinics were chosen from the ED patient logs if their second birthday occurred in the 12 months prior to November 1990; and (2) 91 age-matched control children (control group) were chosen at random from the same hospital-affiliated clinics' enrollment logs without regard to ED use. The health care provided during the first 2 years of life for each group was compared.
  
  
  RESULTS
  The mean number of visits to the ED in the first 2 years of life by the ED group was significantly greater than that of the control group (2.9 [SD] +/- 2.5 vs 1.1 +/- 1.4; P < .001) during the first 2 years of life. In 67% of ED visits, children would have been well enough to receive a vaccination. Both groups had similar types and numbers of visits to the primary clinics. For example, the ED group had 10 +/- 5 visits by age 2 years compared with the control group, which had 9 +/- 4 visits. There was no significant difference in actual immunization percentages achieved in the clinic, with 62% of the ED group having received four diphtheria, pertussis, and tetanus vaccinations; three oral poliovirus vaccinations; and one measles, mumps, and rubella vaccination by age 2 compared with 69% of control children. There were more missed vaccination opportunities during clinic visits in the ED group (7.4 vs 4.6 per 100 clinic visits; P < .01). If immunizations were offered in the ED to those children who needed them, immunization percentages would have been increased an average of 20% compared with percentages achieved in the clinic alone.
  
  
  CONCLUSIONS
  Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.
authors.affiliation: Children's Hospital of Philadelphia, PA 19104.
authors.forename: L M
authors.initials: LM
authors.lastname: Bell
authors.forename: N I
authors.initials: NI
authors.lastname: Lopez
authors.forename: J
authors.initials: J
authors.lastname: Pinto-Martin
authors.forename: R
authors.initials: R
authors.lastname: Casey
authors.forename: F M
authors.initials: FM
authors.lastname: Gill
mesh_terms: D002662:Child Health Services; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007114:Immunization; D007223:Infant; D008297:Male; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies