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Point-of-care testing for tetanus immunity: a systematic review and meta-analysis
  1. Rachel Low1,
  2. Kieron Young1,
  3. Lorenzo Verani1,
  4. Daniele T Cotton1,
  5. Ted Welman2,
  6. Luke S P Moore1,3,
  7. Maxim D Horwitz3
  1. 1Imperial College London, London, UK
  2. 2Barts Health NHS Trust, London, UK
  3. 3Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Ted Welman, Barts Health NHS Trust, London, UK; tedwelman{at}doctors.org.uk

Abstract

Background The current standard of care for tetanus prophylaxis management in patients with open wounds likely results in overtreatment and unnecessary costs. Point-of-care immunochromatographic tests, known as Tetanus Quick Sticks (TQS), have been developed to qualitatively measure tetanus immunoglobulin levels. Multiple studies advocate their use in EDs. We aim to evaluate the diagnostic accuracy and cost-effectiveness of TQS to assess their relevance in frontline emergency care.

Methods A systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted in MEDLINE, Embase, Global Health, The Health Management Information Consortium and The Cochrane Library. Studies were eligible if sensitivity, specificity or cost-efficacy of TQS was reported. At least two authors independently assessed and extracted data from each study. A meta-analysis was conducted to evaluate summary sensitivity and specificity estimates for TQS.

Results 12 studies were suitable for inclusion (n=1 662 865 participants): 1 modelling and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy; the summary estimate for sensitivity was 90% (95% CI, 89% to 90%) with specificity 97% (95% CI, 95% to 100%). Six studies investigated cost-efficacy, reporting lower healthcare costs when using TQS instead of the current method of vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration. Based on the current NHS supply chain data, TQS use could save £173.05 per tetanus-prone patient.

Conclusion TQS could confer the greatest cost savings if used in combination with vaccination history in patients with tetanus-prone wounds. A quality assurance process is recommended prior to implementation of TQS in EDs.

  • trauma
  • infections
  • cost-benefit analysis
  • wounds and injuries

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • RL and KY are joint first authors.

  • Handling editor Roland C Merchant

  • RL and KY contributed equally.

  • Contributors TW, LSPM and MDH researched the literature and conceived the study. RL, KY, LV, DTC, TW, LSPM and MDH were involved in the development of the protocol and study design. RL, KY, LV and DTC were principally involved in performing the search, data analysis and writing the first draft of the manuscript. All authors reviewed, edited and approved the final manuscript. TW is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LSPM has consulted for/received speaker fees from DNAelectronics (2015-18), Dairy Crest (2017–2018), bioMerieux (2013-2021), Umovis Lab (2020), Profile Pharma (2018-2019), Eumedica (2016-2021), Pfizer (2018-2021), Pulmocide (2021) and Shionogi (2021), and received research grants from the National Institute for Health Research (2013-2020), CW+ Charity (2018-2020), LifeArc (2020-2021), and Leo Pharma (2016).

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.