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Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study
  1. Muriel Stubbe1,
  2. Luc J M Mortelmans2,
  3. Didier Desruelles3,
  4. Rohnny Swinnen1,
  5. Marc Vranckx4,
  6. Edmond Brasseur5,
  7. Philippe E Lheureux1
  1. 1Department of Emergency Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
  2. 2Department of Emergency Medicine, Klina Hospital, Brasschaat, Belgium
  3. 3Department of Emergency Medicine, Gasthuisberg University Hospital, Leuven, Belgium
  4. 4Department of Emergency Medicine, Tubize-Nivelles Hospital, Tubize, Belgium
  5. 5Department of Emergency Medicine, Liège University Hospital, Liège, Belgium
  1. Correspondence to:
 Muriel Stubbe
 Department of Emergency Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium; muriel.stubbe{at}


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.

  • ED, emergency department
  • ELISA, enzyme linked immunosorbent assay
  • NPV, negative predictive value
  • PPV, positive predictive value
  • TD, tetanus combined with diphtheria anatoxin vaccine
  • TQS, Tétanos Quick Stick
  • TT, tetanus toxoid
  • tetanus prophylaxis
  • wound
  • immunologic test
  • cost-effectiveness
  • algorithm

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  • An investigation group of the Belgian Society of Emergency and Disaster Medicine (BeSEDiM).

  • Competing interests: None.