Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study
Background: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve...
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| Veröffentlicht in: | Emergency medicine journal : EMJ 2007-09, Vol.24 (9), p.648-653 |
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| creator | Stubbe, Muriel Mortelmans, Luc J M Desruelles, Didier Swinnen, Rohnny Vranckx, Marc Brasseur, Edmond Lheureux, Philippe E |
| description | Background: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. Objectives: To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. Method: In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. Results: The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (€10.58/patient with the TQS versus €11.34/patient without). The benefits of the TQS use were significantly greater in patients |
| doi_str_mv | 10.1136/emj.2007.048520 |
| format | Article |
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Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. Objectives: To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. Method: In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. Results: The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (€10.58/patient with the TQS versus €11.34/patient without). The benefits of the TQS use were significantly greater in patients <61 years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) of cases and the mean cost per patient reduced to €8.31. Conclusion: In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result.</description><identifier>ISSN: 1472-0205</identifier><identifier>ISSN: 1472-0213</identifier><identifier>EISSN: 1472-0213</identifier><identifier>DOI: 10.1136/emj.2007.048520</identifier><identifier>PMID: 17711944</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</publisher><subject>Adult ; Age ; algorithm ; Algorithms ; Analysis of Variance ; Belgium ; Chi-Square Distribution ; Cost benefit analysis ; cost-effectiveness ; Double-Blind Method ; ELISA ; Emergency ; emergency department ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Female ; Hospitals ; Human health sciences ; Humans ; immunologic test ; Immunologic Tests ; Immunologie & maladie infectieuse ; Immunology & infectious disease ; Male ; Medical records ; Middle Aged ; negative predictive value ; NPV ; Original ; positive predictive value ; PPV ; Predictive Value of Tests ; prophylaxis ; Prospective Studies ; Rural areas ; Sciences de la santé humaine ; TETANUS ; Tetanus - immunology ; Tetanus - prevention & control ; Tetanus Antitoxin - administration & dosage ; Tetanus Antitoxin - economics ; tetanus combined with diphtheria anatoxin vaccine ; tetanus prophylaxis ; tetanus toxoid ; TQS ; Tétanos Quick Stick ; Vaccines ; wound</subject><ispartof>Emergency medicine journal : EMJ, 2007-09, Vol.24 (9), p.648-653</ispartof><rights>Copyright 2007 by the Emergency Medicine Journal</rights><rights>Copyright: 2007 Copyright 2007 by the Emergency Medicine Journal</rights><rights>Copyright ©2007 Emergency Medicine Journal.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b536t-9dca0217623f5b02293e23386f221dc17c5649063e01d84ce032125423488b693</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://emj.bmj.com/content/24/9/648.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://emj.bmj.com/content/24/9/648.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,230,314,723,776,780,881,3183,23552,27903,27904,53769,53771,77346,77377</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17711944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stubbe, Muriel</creatorcontrib><creatorcontrib>Mortelmans, Luc J M</creatorcontrib><creatorcontrib>Desruelles, Didier</creatorcontrib><creatorcontrib>Swinnen, Rohnny</creatorcontrib><creatorcontrib>Vranckx, Marc</creatorcontrib><creatorcontrib>Brasseur, Edmond</creatorcontrib><creatorcontrib>Lheureux, Philippe E</creatorcontrib><creatorcontrib>Belgian Society of Emergency and Disaster Medicine</creatorcontrib><title>Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study</title><title>Emergency medicine journal : EMJ</title><addtitle>Emerg Med J</addtitle><description>Background: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. Objectives: To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. Method: In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. Results: The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (€10.58/patient with the TQS versus €11.34/patient without). The benefits of the TQS use were significantly greater in patients <61 years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) of cases and the mean cost per patient reduced to €8.31. Conclusion: In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result.</description><subject>Adult</subject><subject>Age</subject><subject>algorithm</subject><subject>Algorithms</subject><subject>Analysis of Variance</subject><subject>Belgium</subject><subject>Chi-Square Distribution</subject><subject>Cost benefit analysis</subject><subject>cost-effectiveness</subject><subject>Double-Blind Method</subject><subject>ELISA</subject><subject>Emergency</subject><subject>emergency department</subject><subject>Emergency Service, Hospital</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>Hospitals</subject><subject>Human health sciences</subject><subject>Humans</subject><subject>immunologic test</subject><subject>Immunologic Tests</subject><subject>Immunologie & maladie infectieuse</subject><subject>Immunology & infectious disease</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>negative predictive value</subject><subject>NPV</subject><subject>Original</subject><subject>positive predictive value</subject><subject>PPV</subject><subject>Predictive Value of Tests</subject><subject>prophylaxis</subject><subject>Prospective Studies</subject><subject>Rural areas</subject><subject>Sciences de la santé humaine</subject><subject>TETANUS</subject><subject>Tetanus - immunology</subject><subject>Tetanus - prevention & control</subject><subject>Tetanus Antitoxin - administration & dosage</subject><subject>Tetanus Antitoxin - economics</subject><subject>tetanus combined with diphtheria anatoxin vaccine</subject><subject>tetanus prophylaxis</subject><subject>tetanus toxoid</subject><subject>TQS</subject><subject>Tétanos Quick Stick</subject><subject>Vaccines</subject><subject>wound</subject><issn>1472-0205</issn><issn>1472-0213</issn><issn>1472-0213</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkstv1DAQxiMEomXhzA1FQuKAyNavOEkPSLCiUFGBQKUHLiPHmWS95IXtrLr_Pd5mtTwunDzW_GbG8_mLoqeULCnl8gy7zZIRki2JyFNG7kWnVGQsIYzy-8eYpCfRI-c2hNC0EPnD6IRmGaWFEKfRcNmNdtiavok9etVPLg73cb1r1a1xseljv8YYO7QN9noXVzgq6zvs_Xms9qgbUXuzxVdxNUxli0nZmr6K9eB8gnU9J3t0LnZ-qnaPowe1ah0-OZyL6NvFu-vVh-Tq8_vL1ZurpEy59ElRaRWWyCTjdVoSxgqOjPNc1ozRStNMp1IURHIktMqFRsIZZalgXOR5KQu-iF7Pfcep7LDS4cFWtTBa0ym7g0EZ-DvTmzU0wxaYkEJyFhrwuUFrsEEYbGlgy-4K7-KpbUBpKBEYkzkERYtQt4heHMba4eeEzkNnnMa2VT0OkwOZB9lJkQXw-T_gZphsHyQJrXISvrSgeaDOZkoHoZ3F-rgAJbA3AAQDwN4AMBsgVDz7c-_f_OHHA5DMgHEeb495ZX-AzHiWwqebFXy__njx9svNV9jr8HLmyzDpf9N_ATtSyTs</recordid><startdate>200709</startdate><enddate>200709</enddate><creator>Stubbe, Muriel</creator><creator>Mortelmans, Luc J M</creator><creator>Desruelles, Didier</creator><creator>Swinnen, Rohnny</creator><creator>Vranckx, Marc</creator><creator>Brasseur, Edmond</creator><creator>Lheureux, Philippe E</creator><general>BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>U9A</scope><scope>7X8</scope><scope>Q33</scope><scope>5PM</scope></search><sort><creationdate>200709</creationdate><title>Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study</title><author>Stubbe, Muriel ; Mortelmans, Luc J M ; Desruelles, Didier ; Swinnen, Rohnny ; Vranckx, Marc ; Brasseur, Edmond ; Lheureux, Philippe E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b536t-9dca0217623f5b02293e23386f221dc17c5649063e01d84ce032125423488b693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Age</topic><topic>algorithm</topic><topic>Algorithms</topic><topic>Analysis of Variance</topic><topic>Belgium</topic><topic>Chi-Square Distribution</topic><topic>Cost benefit analysis</topic><topic>cost-effectiveness</topic><topic>Double-Blind Method</topic><topic>ELISA</topic><topic>Emergency</topic><topic>emergency department</topic><topic>Emergency Service, Hospital</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>Hospitals</topic><topic>Human health sciences</topic><topic>Humans</topic><topic>immunologic test</topic><topic>Immunologic Tests</topic><topic>Immunologie & maladie infectieuse</topic><topic>Immunology & infectious disease</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>negative predictive value</topic><topic>NPV</topic><topic>Original</topic><topic>positive predictive value</topic><topic>PPV</topic><topic>Predictive Value of Tests</topic><topic>prophylaxis</topic><topic>Prospective Studies</topic><topic>Rural areas</topic><topic>Sciences de la santé humaine</topic><topic>TETANUS</topic><topic>Tetanus - immunology</topic><topic>Tetanus - prevention & control</topic><topic>Tetanus Antitoxin - administration & dosage</topic><topic>Tetanus Antitoxin - economics</topic><topic>tetanus combined with diphtheria anatoxin vaccine</topic><topic>tetanus prophylaxis</topic><topic>tetanus toxoid</topic><topic>TQS</topic><topic>Tétanos Quick Stick</topic><topic>Vaccines</topic><topic>wound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stubbe, Muriel</creatorcontrib><creatorcontrib>Mortelmans, Luc J M</creatorcontrib><creatorcontrib>Desruelles, Didier</creatorcontrib><creatorcontrib>Swinnen, Rohnny</creatorcontrib><creatorcontrib>Vranckx, Marc</creatorcontrib><creatorcontrib>Brasseur, Edmond</creatorcontrib><creatorcontrib>Lheureux, Philippe E</creatorcontrib><creatorcontrib>Belgian Society of Emergency and Disaster Medicine</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Université de Liège - Open Repository and Bibliography (ORBI)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Emergency medicine journal : EMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stubbe, Muriel</au><au>Mortelmans, Luc J M</au><au>Desruelles, Didier</au><au>Swinnen, Rohnny</au><au>Vranckx, Marc</au><au>Brasseur, Edmond</au><au>Lheureux, Philippe E</au><aucorp>Belgian Society of Emergency and Disaster Medicine</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study</atitle><jtitle>Emergency medicine journal : EMJ</jtitle><addtitle>Emerg Med J</addtitle><date>2007-09</date><risdate>2007</risdate><volume>24</volume><issue>9</issue><spage>648</spage><epage>653</epage><pages>648-653</pages><issn>1472-0205</issn><issn>1472-0213</issn><eissn>1472-0213</eissn><abstract>Background: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. Objectives: To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. Method: In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. Results: The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (€10.58/patient with the TQS versus €11.34/patient without). The benefits of the TQS use were significantly greater in patients <61 years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) of cases and the mean cost per patient reduced to €8.31. Conclusion: In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</pub><pmid>17711944</pmid><doi>10.1136/emj.2007.048520</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1472-0205 |
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| source | MEDLINE; BMJ Journals - NESLi2; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Adult Age algorithm Algorithms Analysis of Variance Belgium Chi-Square Distribution Cost benefit analysis cost-effectiveness Double-Blind Method ELISA Emergency emergency department Emergency Service, Hospital Enzyme-Linked Immunosorbent Assay Female Hospitals Human health sciences Humans immunologic test Immunologic Tests Immunologie & maladie infectieuse Immunology & infectious disease Male Medical records Middle Aged negative predictive value NPV Original positive predictive value PPV Predictive Value of Tests prophylaxis Prospective Studies Rural areas Sciences de la santé humaine TETANUS Tetanus - immunology Tetanus - prevention & control Tetanus Antitoxin - administration & dosage Tetanus Antitoxin - economics tetanus combined with diphtheria anatoxin vaccine tetanus prophylaxis tetanus toxoid TQS Tétanos Quick Stick Vaccines wound |
| title | Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study |
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