Introduction: Based on the existing studies, measuring serum level of immunoglobulin for making decisions regarding prescription of tetanus prophylaxis seems logical and cost effective. Therefore, the present study was done with the aim of evaluating the diagnostic accuracy of tetanus quick stick (TQS) in comparison with ELISA method in this regard.
Methods: The present diagnostic accuracy study was carried out on trauma patients presenting to emergency department, who were in need of receiving tetanus prophylaxis due to dirty wounds or injuries. Patients’ blood was evaluated regarding presence of anti-tetanus antibody via TQS and ELISA methods and screening performance characteristics of TQS in identifying the cases in need of receiving prophylaxis was calculated compared to ELISA as the reference test.
Results: 148 patients with the mean age of 34.58 ± 15.86 years (4-86) were studied (87.8% male). Agreement rate between the results of TQS and ELISA was 0.78 based on calculation of kappa coefficient. Sensitivity, specificity and area under the ROC curve of TQS were estimated to be 100 (95% CI: 96.50 – 100), 66.66 (95% CI: 38.68 – 86.01), and 0.83 (95% CI: 0.68 – 0.98), respectively. If TQS was used, the cost of treatment regarding use of tetabulin could have a 91.7% reduction.
Conclusion: Based on the findings of the present study, TQS has good diagnostic accuracy in comparison with ELISA and considering its 100% sensitivity and negative predictive value in cases with dirty wound, it can be considered as a reliable tool for screening patients that do not need to receive anti-tetanus prophylaxis.
Yoon YS, Kim EC, Lee WH, Chung SW, Yi JH, Park IC, et al. Utility of tetanos quick stick (R) test for selective tetanus prophylaxis. Journal of the Korean Society of Emergency Medicine. 2004;15(2):95-101.
Cooke M. Are current UK tetanus prophylaxis procedures for wound management optimal? Emergency Medicine Journal. 2009;26(12):845-8.
N'Diaye DS, Schwarzinger M, Obach D, Poissy J, Matheron S, Casalino E, et al. Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in french emergency departments. BMC infectious diseases. 2014;14(1):1.
Borrow R, Balmer P, Roper MH. VBThe immunological basis for immunization series Module 3: Tetanus. 2007.
Cavenaile J-C, Gérard P, Duchateau J. Évaluation d’un test rapide immuno-chromatographique comme aide à la prophylaxie antitétanique dans un service d’urgences. Immuno-analyse & Biologie Spécialisée. 2012;27(4):185-90.
Colombet I, Saguez C, Sanson-Le Pors M-J, Coudert B, Chatellier G, Espinoza P. Diagnosis of tetanus immunization status: multicenter assessment of a rapid biological test. Clinical and diagnostic laboratory immunology. 2005;12(9):1057-62.
Elkharrat D, Sanson-Le-Pors M, Arrouy L, Beauchet A, Benhamou F. Evaluation of a bedside immunotest to predict individual anti-tetanus seroprotection: a prospective concordance study of 1018 adults in an emergency department. Emergency Medicine Journal. 2010;27(1):36-42.
Derakhshanfar H, Hashemi B, Manouchehrifar M, Kashani P, Forouzanfar MM. Knowledge of Emergency Medicine Residents in Relation to Prevention of Tetanus. Emergency. 2014;2(2):71.
Committee PF. BNF for Children: 2012-2013: Pharmaceutical Press; 2012.
Barrett T, Lander A, Diwakar V. A Paediatric Vade-Mecum: CRC Press; 2002.
Committee IA. Immunisation guidelines for Ireland. Royal College of Physicians of Ireland. 2010.
Organization WH. WHO position on measles vaccines. Vaccine. 2009;27(52):7219-21.
Roper MH, Vandelaer JH, Gasse FL. Maternal and neonatal tetanus. The Lancet. 2007;370(9603):1947-59.
Stubbe M, Mortelmans LJ, Desruelles D, Swinnen R, Vranckx M, Brasseur E, et al. Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study. Emergency Medicine Journal. 2007;24(9):648-53.
Stubbe M, Swinnen R, Crusiaux A, Mascart F, Lheureux PE. Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest. European journal of emergency medicine. 2007;14(1):14-24.
Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet. 2015;385(9966):430-40.
Orimadegun AE, Orimadegun BE, Adepoju AA. Immunity against tetanus infection, risk factors for non-protection, and validation of a rapid immunotest kit among hospitalized children in Nigeria. Frontiers in neurology. 2013;4:142.
Hatamabadi HR, Abdalvand A, Safari S, Kariman H, Dolatabadi AA, Shahrami A, et al. Tetanus Quick Stick as an applicable and cost-effective test in assessment of immunity status. The American journal of emergency medicine. 2011;29(7):717-20.
Paulke‐Korinek M, Rendi‐Wagner P, Kundi M, Tomann B, Wiedermann U, Kollaritsch H. Pretravel consultation: rapid dipstick test as a decision guidance for the application of tetanus booster vaccinations. Journal of travel medicine. 2008;15(6):437-41.
Orsi G, Modini C, Principe M, Di Muzio M, Moriconi A, Amato M, et al. Assessment of tetanus immunity status by tetanus quick stick and anamnesis: a prospective double blind study. Ann Ig. 2015;27(2):467-74.