Background: Little is known about physicians' adherence to the 2006 Advisory Committee on Immunization Practices (ACIP) recommendation that providers strongly should consider observing vaccine recipients for 15 minutes to prevent injuries from postvaccination syncope.

Purpose: To assess physicians' knowledge, attitudes, and practices toward observing adolescents for 15 minutes postvaccination.

Methods: A survey was administered during October 2008-January 2009 to 425 pediatricians (Peds) and 424 family medicine physicians (FPs) from a nationally representative network. Adherence was defined as reporting routinely observing patients for ≥15 minutes after vaccination. Data analysis was completed in 2009.

Results: The overall response rate was 73%. A minority of physicians (37% Peds, 24% FPs) were aware that ACIP strongly encourages observing patients for 15 minutes postvaccination, but most physicians (69% Peds, 84% FPs) thought that their practice easily could adhere to this recommendation. Lack of room space (76% Peds, 65% FPs) was the most frequently reported barrier. Seventeen percent of physicians reported adherence to postvaccination observation. Practice in a hospital, university, or community health center compared with private practice (RR=1.64, 95% CI=1.05, 2.40); awareness of the ACIP syncope recommendation (RR=5.55, 95% CI=3.60, 9.37); and believing that postvaccination syncope can result in serious injuries (RR=1.74, 95% CI=1.06, 4.22) were independently associated with self-reported adherence.

Conclusions: Few physicians are aware of recommendations for postvaccination observation for syncope and even fewer adhere to them. Strategies to improve this should be developed and tested.