Adherence to Recommendations to Prevent Traumatic Injuries From Postvaccination Syncope: a National Physician Survey

Background: The Advisory Committee on Immunization Practices (ACIP) recommends providers strongly consider observing patients for 15 minutes after vaccination to prevent injuries from postvaccination syncope. Little is known about physicians’ adherence to these recommendations.

Objectives: To assess physicians’ knowledge, attitudes, perceived barriers, and practice towards adhering to ACIP recommendations.

Methods: A survey was administered 10/2008–1/2009 to 425 pediatricians (Peds) and 424 family physicians (FM) nationally. Analyses involved physicians who reported immunizing adolescents aged 11 through 18 years. Adherence was defined as routinely observing patients for ≥15 minutes after vaccination. We conducted bivariate analyses comparing Peds and FM by χ² tests and logistic regression to model predictors of adherence.

Results: Response rate was 73% (76% Peds, 71% FM); 594 respondents (315 Peds, 279 FM) immunized adolescents. More Peds than FM were aware of ACIP’s recommendations (37% vs 24%, p<0.01) but fewer Peds than FM thought their practice could easily adhere (69% vs 84%, p<0.01). Reported barriers included lack of room space (76% Peds, 65% FM) and lack of staff (69% Peds, 56% FM). Eighteen percent Peds and 16% FM reported adherence. In multivariate modeling, practicing in hospital/university/community health center compared with private practice settings (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.05–2.40), awareness of ACIP recommendations (RR 5.55; 95% CI 3.60 9.37), belief that postvaccination syncope can result in serious injuries (RR 1.74; 95% CI 1.06–4.22), reporting having adequate room space (RR 1.81; 95% CI 1.26–2.56) and adequate staff (RR 1.88; 95% CI 1.29–2.80) to observe patients were associated with adherence.

Conclusions:Most physicians were unaware of and did not adhere to ACIP syncope recommendations. Efforts should be made to disseminate recommendations, educate physicians about the potential for injuries from postvaccination syncope in adolescents, and identify ways to better implement these recommendations in settings with limited staff and room space.