Immunization Opportunities for Hospitalized Adolescents

IntroductionAdolescents seek routine healthcare, including immunizations, less frequently than any other age group. Hospitalizations are an opportunity to provide immunizations to this vulnerable population. The aims of this study were to assess the accuracy of provider documentation of immunization status and evaluate the prevalence of delayed immunization status in this population. MethodsA retrospective chart review of adolescents discharged from July 2017 to June 2018 from the pediatric hospitalist service of a tertiary care academic childrens hospital was conducted. Provider documentation of immunization status was compared to the immunization registry ALERT Immunization Information System (ALERT IIS) linked to the electronic medical record using descriptive statistics. ResultsProvider documentation of up-to-date on all immunizations had a sensitivity of 60% and specificity of 55%, with 84% of patients needing at least one immunization despite 48% of patients being documented as up-to-date by providers. Provider documentation of the immunization status for the HPV, MCV and Tdap immunizations displayed a low sensitivity (10-11%) but a high specificity (97-100%) while documentation of the influenza immunization was associated with high sensitivity (86%) and low specificity (26%). Provider documentation of immunization status for the HPV, MCV, Tdap and influenza immunizations had positive likelihood ratios of 3.5, 8.5, infinity, and 1.2 with negative likelihood ratios of 0.9, 0.9, 0.9 and 0.53, respectively. ConclusionsProviders inaccurately documented the immunization status for adolescent patients in the inpatient setting. Hospitalizations may provide opportunities to improve immunization rates in adolescents, especially when using state immunization registries.