STRUCTURED GUIDELINES FOR THE USE OF INFLUENZA VACCINE AMONG CHILDRENWITH CHRONIC PULMONARY DISORDERS

National committees recommend annual influenza vaccination for childre n greater than or equal to 6 months of age with chronic pulmonary dise ases, but several studies have suggested that many high risk children do not receive the vaccine, The purpose of this pilot study was to det ermine whether the use of structured guidelines for which pulmonary di sorders warrant influenza vaccination would increase agreement among p hysicians on whether specific children should be vaccinated, Hospital records of 73 children with an outpatient appointment during the previ ous month in the pulmonary, allergy or high risk neonatology clinics w ere reviewed independently by 4 pediatricians. Two reviewers used a se t of specific guidelines in deciding whether influenza vaccination was indicated, whereas the other 2 used unspecified clinical judgment. In terrater agreement concerning the advisability of vaccination was high er between the reviewers using the guidelines (overall agreement, 0.89 ; kappa = 0.73) than between the reviewers using clinical judgment (ov erall agreement, 0.68; kappa = 0.31), Even among the 34 children for w hom all 4 reviewers thought the vaccine advisable, only 13 (38%) had b een vaccinated. Studies to define the risk of severe influenza among c hildren with specific lung disorders are needed, but these guidelines can serve as a starting point for the identification of children who d eserve individual consideration for annual influenza vaccination.