Department of Emergency Medicine, Imam Hosain Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran.
Am J Emerg Med. 2011 Sep;29(7):717-20. doi: 10.1016/j.ajem.2010.01.046. Epub 2010 May 1.
Tetanus vaccine and immunoglobulin administration are challenging decisions mostly because of the fact that the current protocol for immunization against tetanus is based on 2 variables: the vaccination status of the patient and the nature of wound and its exposure. To solve this problem, Tetanus Quick Stick (TQS; Nephrotek Laboratory, Rungis, France), an immunochromatographic dipstick test, was developed to determine the tetanus immunity of the patients. The aim of this present study was to investigate the sensitivity, specificity, and the positive and negative predictive values and cost-effectiveness of TQS in the emergency department (ED) setting.
Blood samples were collected from 200 patients presenting to our ED. Information including demographic information, tetanus immunization status, wound description, and the preventive measures taken by the emergency physician were gathered by a preeducated nurse. Tetanus Quick Stick test and enzyme-linked immunosorbent assay were performed as the standard diagnostic test by an emergency physician and a laboratory technician, respectively; and results of the 2 techniques were compared.
Overall, tetanus vaccine was administered to 141(70.5%) patients and immunoglobulin to 105 (52.5%) patients. The analysis revealed 88.1% sensitivity and 97.6% specificity for the TQS test. The positive and negative predictive values of TQS test were 99.3% and 66.1%, respectively. Our analysis is also showed a significant decrease in cost when TQS was applied for patients with dirty, tetanus prone wounds or injuries and unknown or incomplete vaccination history (€ 9.48 versus € 12.1).
This study revealed TQS test to be appropriate and cost-effective for ED use especially in evaluating patients who do not remember or cannot give their tetanus immunization history.
破伤风疫苗和免疫球蛋白的使用是一个具有挑战性的决策，主要是因为目前针对破伤风的免疫接种方案基于两个变量：患者的疫苗接种状况和伤口的性质及其暴露程度。为了解决这个问题，开发了一种免疫层析试纸条测试（Tetanus Quick Stick，TQS；Nephrotek Laboratory，Rungis，法国），用于确定患者的破伤风免疫力。本研究旨在调查 TQS 在急诊科（ED）环境中的敏感性、特异性、阳性和阴性预测值以及成本效益。
从就诊于我们 ED 的 200 名患者中采集血样。通过一名受过教育的护士收集包括人口统计学信息、破伤风免疫状况、伤口描述以及急诊医生采取的预防措施在内的信息。由一名急诊医生和一名实验室技术员分别进行 Tetanus Quick Stick 测试和酶联免疫吸附试验作为标准诊断测试；并比较两种技术的结果。
总体而言，141 名（70.5%）患者接种了破伤风疫苗，105 名（52.5%）患者接种了免疫球蛋白。分析显示 TQS 测试的敏感性为 88.1%，特异性为 97.6%。TQS 测试的阳性和阴性预测值分别为 99.3%和 66.1%。我们的分析还表明，当 TQS 应用于有脏污、易患破伤风的伤口或损伤以及未知或不完全疫苗接种史的患者时，成本显著降低（€9.48 与 €12.1）。
这项研究表明 TQS 测试特别适用于 ED 使用，并且具有成本效益，尤其适用于那些不记得或无法提供破伤风免疫接种史的患者。
