Evaluation of Vaccine Administration for Post-Splenectomy Patients Following Trauma

Author(s):
Sara Parli; Mary Kate Kerbler; Jacqueline Dempsey; William Olney; Zachary Warriner; Andrew Bernard; Kathryn Ruf

Background:

Patients who underwent emergent splenectomy require several vaccinations per current CDC ACIP recommendations due to overwhelming post-splenectomy infection risk. These include administration of Haemophilus influenza, Meningococcal, and pneumococcal vaccines. In 2015, these recommendations were updated to include an additional Meningococcal vaccination, serogroup B. Boosters of both meningococcal and pneumococcal vaccinations are also recommended. The purpose of this study was to evaluate the vaccination status of patients during index hospitalization and outpatient follow up as well as utilization of the enterprise electronic health record order set.

Hypothesis:

We hypothesized that patients receive recommended vaccinations prior to discharge but that booster compliance is low.

Methods:

This retrospective cohort study, included adults who presented to a trauma center for the treatment of traumatic splenic injury requiring splenectomy between 10/1/2017 to 5/31/2021. Those who died during admission or received both sets of vaccinations during index hospital stay were excluded. Subjects were identified from the adult trauma registry. Further data collection from Vizient and chart review included demographics, mechanism of trauma, intensive care unit length of stay (LOS), hospital LOS, vaccine orders, vaccine administration dates, including initial and booster doses, and hospital readmission within 30 days. The primary outcome was compliance with our post-splenectomy guideline for vaccine administration during index hospitalization. Secondary outcomes included the use of our enterprise EHR order set as well as compliance with booster vaccination.

Results:

117 patients were identified by adult trauma registry. 21 patients were excluded leaving 96 patients to be evaluated. Of the 96 patients included, 3 did not receive all initial vaccines per recommendations. There was only one incidence where the EHR order set was not used, but this patient received all vaccines. 16 patients received any vaccinations (16.7%) in follow up, while only 5 received all three recommended vaccinations requiring booster. Of those that did not complete the full series, pneumococcal 23 valent was most likely to be omitted from administration (62.5%).

Conclusions:

Overall, post-splenectomy patients following trauma had a high compliance rate with initial vaccine administration during index hospitalization. There was also high utilization of the institutional EHR order set for these patients. Adherence to booster vaccines 8 weeks after initial vaccine administration, post-discharge from initial stay due to trauma was alarmingly low.