Objective  To investigate the current application of tetanus passive immune preparation in a children’s hospital and to assess the extent of potentially unnecessary use attributable to missing vaccination records using a theoretical model, thereby informing strategy optimization.

Methods  We retrospectively reviewed the records of children who received prophylactic tetanus passive immune preparation in the outpatient and emergency departments of a children’s hospital in 2023. Focusing on a subgroup of xiamen-registered children born in or after 2018, a decision-tree model was constructed based on the Diagnosis and Treatment Guidelines for Tetanus in Non-Newborns to quantify the potential unnecessary administration rate due to unavailable vaccination history. Additionally, a knowledge and practice questionnaire was distributed to all surgeons in the hospital to analyze associated factors.

Results  A total of 1,900 children were included. Tetanus antitoxin (TAT) and human tetanus immunoglobulin (HTIG) were administered in 62.89% and 37.11% of cases, respectively, with a TAT allergy reaction rate of 6.80%. Model analysis of the target subgroup (n=777, comprising 96.78% high-risk exposures) revealed a potentially unnecessary administration rate as high as 90.35% due to missing records. Sensitivity analysis indicated that this rate would increase to 95.11% if the regional tetanus toxoid vaccination coverage reached 95%. All 50 surgeons received the questionnaire, with 42 valid responses (effective response rate of 84%). Surgeons’ knowledge of tetanus passive immunization in clinical practice, and showed that their decisions were frequently influenced by non-medical factors, such as vaccine service accessibility and medical dispute prevention, in addition to wound characteristics.

Conclusion  The absence of vaccination history records is the primary systemic factor of potentially unnecessary passive immunization. The survey findings suggested that deficiencies in clinicians’ practical knowledge and the impact of non-medical considerations in decision-making are also key contributing factors to potentially unnecessary use. Priorities should include establishing a regional immunization information platform for real-time clinical access and enhancing standardized training for medical staff to fundamentally reduce unnecessary prophylaxis caused by information barriers.

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