Savioli Gabriele, Ceresa Iride Francesca, Giordano Mauro, Ferrari Ilaria, Varesi Angelica, Floris Valentina, Esposito Ciro, Croesi Barbara, Ricevuti Giovanni, Calvi Monica, Bressan Maria Antonietta, Oddone Enrico
Emergency Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.
Ph.D University of Pavia, Pavia, Italy.
Front Med (Lausanne). 2021 Oct 28;8:684594. doi: 10.3389/fmed.2021.684594. eCollection 2021.
Tetanus infection remains a significant complication of wounds. Because most tetanus treatment guidelines rely on anamnestic data collected directly from patients, the congruence between anamnesis and laboratory evidence must be verified, especially in the elderly population. Assess, in both the geriatric population (>65) and the non-geriatric one, the reliability of anamnestic data for managing patients with tetanus-risk wounds, identified categories of populations most exposed to non-vaccination coverage, and assessed the agreement of the Tetanos Quick Stick (TQS) results with the therapy performed (administration of tetanus vaccine or immunoglobulin). In this retrospective single-center observational study, patients were asked their immunization status against tetanus vaccination. The decision to administer a vaccine or immunoglobulin was therefore clinical and based on anamnestic criteria. The TQS test was then given to patients who were unaware of their immunity status. Patients who thought they knew it but were not sure were given the TQS test to determine whether the anamnestic collection was supported by the test. The TQS test results were compared with the anamnestic data. Most patients, geriatric and not geriatric, did not know their immune status. Among those who reported knowing their immune status, there was no agreement between the vaccine coverage declared by patients and the TQS test results ( < 0.001), mainly in geriatric patients but also in the control group. Elderly and women had significantly lower positive TQS test results ( < 0.001). There was a statistically significant discrepancy ( < 0.001) between the therapy based on anamnestic data and the TQS test results. The reliability of anamnestic data for the management of patients with tetanus-risk wounds is low and decreases with age, becoming minimal in geriatric patients. Elderly and women are less likely to have an effective vaccination status against tetanus.
破伤风感染仍然是伤口的一种重要并发症。由于大多数破伤风治疗指南依赖于直接从患者那里收集的既往病史数据，因此必须验证既往病史与实验室证据之间的一致性，尤其是在老年人群中。评估老年人群（>65岁）和非老年人群中，用于管理有破伤风风险伤口患者的既往病史数据的可靠性，确定未接种疫苗覆盖率最高的人群类别，并评估破伤风快速检测棒（TQS）结果与所进行治疗（破伤风疫苗或免疫球蛋白的接种）之间的一致性。在这项回顾性单中心观察性研究中，询问了患者的破伤风疫苗接种免疫状况。因此，接种疫苗或免疫球蛋白的决定是临床性的，且基于既往病史标准。然后对不知道自己免疫状况的患者进行TQS检测。那些认为自己知道但不确定的患者也进行TQS检测，以确定既往病史收集是否得到检测结果的支持。将TQS检测结果与既往病史数据进行比较。大多数患者，无论老年还是非老年，都不知道自己的免疫状况。在那些报告知道自己免疫状况的患者中，患者宣称的疫苗接种覆盖率与TQS检测结果之间不一致（<0.001）主要在老年患者中出现，但对照组中也存在。老年患者和女性的TQS检测阳性结果显著较低（<0.001）。基于既往病史数据的治疗与TQS检测结果之间存在统计学上的显著差异（<0.001）。用于管理有破伤风风险伤口患者的既往病史数据的可靠性较低，且随年龄增长而降低，在老年患者中降至最低。老年患者和女性获得有效破伤风疫苗接种状态的可能性较小。
