title: Tetanus Quick Stick as an applicable and cost-effective test in assessment of immunity status.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Imam Hosain Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Hatamabadi
authors.forename: Ali
authors.initials: A
authors.lastname: Abdalvand
authors.forename: Saeed
authors.initials: S
authors.lastname: Safari
authors.forename: Hamid
authors.initials: H
authors.lastname: Kariman
authors.forename: Ali Arhami
authors.initials: AA
authors.lastname: Dolatabadi
authors.forename: Ali
authors.initials: A
authors.lastname: Shahrami
authors.forename: Hossein
authors.initials: H
authors.lastname: Alimohammadi
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hosseini
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007159:Immunologic Tests / Q000191:economics / Q000295:instrumentation / Q000379:methods; D008297:Male; D019095:Point-of-Care Systems / Q000191:economics; D011934:Reagent Strips / Q000191:economics; D012680:Sensitivity and Specificity; D013742:Tetanus / Q000276:immunology* / Q000517:prevention & control; D013745:Tetanus Toxoid / Q000276:immunology; D014947:Wounds and Injuries / Q000276:immunology
chemical_list: D011934:Reagent Strips; D013745:Tetanus Toxoid