Service des Urgences Médico-chirurgicales, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92 100 Boulogne-Billancourt, France.
Emerg Med J. 2010 Jan;27(1):36-42. doi: 10.1136/emj.2008.068254.
Unscheduled tetanus prophylaxis (UTP) used in the emergency room (ER) in patients with wounds who are unaware of their vaccination history is erroneous in 40% of cases. Evaluation of bedside tetanus immunity with the Tétanos Quick Stick (TQS) test may improve UTP.
To show that (1) a positive TQS result reflects immunity to tetanus; and (2) TQS is reproducible by ER workers.
In a prospective concordance study, immunity to tetanus of patients with wounds was assessed by two techniques: (1) TQS at the bedside, which detects specific tetanus antitoxins at concentrations > or =0.2 IU/ml in whole blood or > or =0.1 IU/ml in serum; (2) ELISA in the laboratory (threshold >0.1 IU/ml). The study comprised three groups: (A) healthcare personnel self-tested with the two techniques to determine the effect of training; (B) selected patients with wounds were double-tested with TQS by two healthcare providers whose readings were compared to test reproducibility; and (C) all patients with wounds aged > or =15 years were consecutively included.
Of 1018 individuals included, 60 were in group A, 50 were in group B and 908 were in group C. 403 patients who were not included were similar to those included for age, vaccination history and types of wounds. The reproducibility of the test was 98%. TQS sensitivity was 83.0%, specificity 97.5%, positive predictive value 99.6% and negative predictive value 42.9%.
TQS reliably predicts tetanus immunity and is reproducible by healthcare providers. Although it may not accurately discriminate between patients with ongoing and declining immunity, it is currently the most sensitive and specific tool for guiding tetanus prophylaxis and should be included in current guidelines on UTP.
在急诊室（ER）中，对于那些不知道自己接种史的有创伤的患者，不按计划进行破伤风预防（UTP）在 40%的情况下是错误的。使用 Tétanos Quick Stick（TQS）试验在床边评估破伤风免疫力可以改善 UTP。
证明（1）TQS 阳性结果反映了对破伤风的免疫力；（2）TQS 可由急诊室工作人员重复使用。
在一项前瞻性一致性研究中，使用两种技术评估有创伤患者的破伤风免疫力：（1）床边 TQS，它在全血中检测到特异性破伤风抗体，浓度≥0.2IU/ml；或在血清中浓度≥0.1IU/ml；（2）实验室 ELISA（阈值＞0.1IU/ml）。研究包括三组：（A）医护人员自行使用两种技术进行自我测试，以确定培训效果；（B）选择有创伤的患者，由两名医护人员对其进行双重 TQS 测试，比较他们的读数以测试重复性；（C）连续纳入所有年龄≥15 岁的有创伤患者。
在 1018 名入组者中，60 名在组 A，50 名在组 B，908 名在组 C。403 名未纳入的患者在年龄、接种史和创伤类型方面与纳入患者相似。该试验的重复性为 98%。TQS 的灵敏度为 83.0%，特异性为 97.5%，阳性预测值为 99.6%，阴性预测值为 42.9%。
TQS 可靠地预测破伤风免疫力，且可由医护人员重复使用。尽管它可能无法准确区分具有持续和下降免疫力的患者，但它目前是指导破伤风预防最敏感和特异的工具，应包含在当前 UTP 指南中。
