Tetanus Quick Stick as an applicable and cost-effective test in assessment of immunity status

• Published in: The American journal of emergency medicine Vol. 29; no. 7; pp. 717 - 720
• Main Authors: Hatamabadi, Hamid Reza, MD, Abdalvand, Ali, MD, Safari, Saeed, MD, Kariman, Hamid, MD, Dolatabadi, Ali Arhami, MD, Shahrami, Ali, MD, Alimohammadi, Hossein, MD, Hosseini, Mostafa, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Colleges & universities; Cost reduction; Cost-Benefit Analysis; Developing countries; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Enzyme-Linked Immunosorbent Assay; Female; Human bacterial diseases; Humans; Immunization; Immunologic Tests - economics; Immunologic Tests - instrumentation; Immunologic Tests - methods; Infectious diseases; Insurance policies; Intensive care medicine; LDCs; Male; Medical sciences; Medicine; Mortality; Point-of-Care Systems - economics; Preventive medicine; Reagent Strips - economics; Sensitivity and Specificity; Teaching hospitals; Tetanus; Tetanus - immunology; Tetanus - prevention & control; Tetanus Toxoid - immunology; Vaccines; Wound healing; Wounds and Injuries - immunology; Iran; Infection; Costs; Intensive care; Bacteriosis; Tetanus; Immunity; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.01.046

Abstract Introduction 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. Methods 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. Result 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). Conclusion 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.