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Low R, Young K, Verani L, Cotton DT, Welman T, Moore L, Horwitz MD. 540 Point of Care Testing for Tetanus Immunity: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
All patients presenting to emergency departments (EDs) with traumatic injuries require tetanus immunity assessments. Inaccurate tetanus vaccination history based on patient recall incurs unnecessary costs on the NHS. Point-of-care immunochromatographic tests (Tetanus Quick Sticks [TQS]) quickly identify tetanus immunity status. We aim to evaluate the diagnostic accuracy and cost-efficacy of TQS to assess their relevance in emergency care.
Method
The systematic review followed PRISMA guidelines. A retrospective search of MEDLINE, Embase, Global Health, HMIC and The Cochrane Library was conducted. Studies were eligible if sensitivity, specificity, or cost-efficacy of TQS were reported. At least two authors independently analysed the data from each study.
Results
12 studies were suitable for inclusion (n = 1,662,865 participants): one retrospective and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy with the median sensitivity at 86% (55-100) and the median specificity at 97.5% (1-100). All six studies investigating cost-efficacy reported greater savings when using TQS instead of using vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration.
Conclusions
TQS is a safe diagnostic tool, especially when used by trained operators. TQS widely reduces costs in comparison to traditional vaccination history. We recommend the use of TQS in Emergency Departments throughout the NHS.
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Affiliation(s)
- R Low
- Imperial College London, London, United Kingdom
| | - K Young
- Imperial College London, London, United Kingdom
| | - L Verani
- Imperial College London, London, United Kingdom
| | - D T Cotton
- Imperial College London, London, United Kingdom
| | - T Welman
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, United Kingdom
| | - L Moore
- Imperial College London, London, United Kingdom
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M D Horwitz
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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