Immunization Status as Determined by Patients' Hand-Held Cards vs Medical Records

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Abstract
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 (k=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 (k=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. Arch Pediatr Adolesc Med. 1996;150:863-866

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