Download Full Text (655 KB)

Publication Date



Introduction: Children with acute respiratory infection (ARI) often present to hospitals. The Children’s Mercy Hospital (CM) is one of seven sites across the United States within the New Vaccine Surveillance Network (NVSN) funded by the Center for Disease Control (CDC). This network conducts active surveillance of pediatric patients who present with respiratory illness to the inpatient (IP) floors at CM and Children’s Mercy Kansas (CMK) as well as the CM Emergency Department (ED).

Method: From December 1, 2016-July 20, 2018 research coordinators screened patients at IP and ED that presented with ARI symptoms in the past 13 days, were < 18 years of age, and reside in Jackson County, Missouri. Refusals are the highest non-enrollment reason and 40%-60% of eligible patients end up not enrolling in the study. CMK/IP and ED refusals were compared by a number of variables (sex, race, ethnicity, insurance status, enrollment month, enrollment day of the week, and common symptoms).


IP enrollment vs. refusal rates for race are 49% Caucasian enroll vs. 39% refuse, 37% African Americans enroll vs. 42% refuse, 2% Multi-Racial enroll vs. 0% refuse, 2% listed other enrolled vs. 1% refuse, and 10% unknown enrolled vs. 18% refuse. ED enrolment vs. refusal rates for race are 22% Caucasian enroll vs. 14% refuse, 60% African Americans enroll vs. 50% refuse, 3% Multi-Racial enroll vs. 0% refuse, 1% listed other enrolled vs. 1% refused, and 14% unknown enrolled vs. 35% refused. In the ED more non-Hispanics enrolled (80%) than refused (64%). Families that identify as white only enroll more frequently than refuse (8-10%) for both ED and IP. The same applies for families that identify as black only in the ED (10%) difference, whereas IP has similar percentages of enrolled vs. refused for families that identify as black only. Families that identify as Non-Hispanic enroll in the ED more frequently than refuse (15%) while IP has similar percentage for ethnicity enrolled vs. refused.


Sex, insurance status, enrollment month, enrollment day of the week, and common symptoms are not a significant indicator for refusal rates at IP and ED. Both race and ethnicity saw a difference between enrollment and refusals rates for IP and ED. More information is needed with the completion of S17-S18 to obtain additional data and compare findings between study seasons.

Document Type


New Vaccine Surveillance Network-Acture Respiratory Infection (NVSN – ARI) Refusal Rate Analysis: Inpatient vs. Emergency Department



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.