Accuracy of Immunization Histories Provided by Adults Accompanying Preschool Children to a Pediatric Emergency Department

Objective: Because some have advocated the use of emergency departments to administer delayed childhood immunizations, we evaluated the accuracy of immunization histories obtained in this setting by comparison with medical records of inner-city health care facilities.

Design: Questionnaires were orally administered to adults accompanying children to the emergency department. Individual medical records were reviewed.

Setting: Pediatric emergency department at Wyler Children's Hospital, University of Chicago and 68 inner-city primary care clinics.

Patients: Children aged 3 to 65 months registering for medical care. Of the sample, 98% were African American; 75% were Medicaid recipients.

Main Outcome Measures: Adults' knowledge of immunization histories, immunization cards, and medical records compared with American Academy of Pediatrics/Immunization Practices Advisory Committee recommendations.

Results: Of the accompanying adults, 64% stated that their child's general immunization status was "up-to-date"; 65% of these had clinic records confirming that status. Only 8% of specific regimens stated by these adults accurately matched those found in clinic records. Moreover, 45% of adults accompanying children at least 16 months and older provided inaccurate information regarding previous receipt of measles immunization.

Conclusion: Information provided by accompanying adults (from recall or from immunization cards) is inadequate to determine accurately which preschoolers in the pediatric emergency department are delayed in immunizations.