Evaluation of a bedside immunotest to predict individual anti-tetanus seroprotection: a prospective concordance study of 1018 adults in an emergency department

Abstract

TQS reliably predicts tetanus immunity and is reproducible by healthcare providers. Although it may not accurately discriminate between patients with ongoing and declining immunity, it is currently the most sensitive and specific tool for guiding tetanus prophylaxis and should be included in current guidelines on UTP.

Should we test for tetanus immunity in all emergency department patients with wounds?

“…The Protetanus test kit can be used to determine whether an individual patient has a sufficient level of immunity to be protected against tetanus. It is used in Europe under the name Tetanos Quick Stick and has been validated against ELISA measurement of serum tetanus antitoxin level 4 5. It uses a single drop of blood from a finger prick and gives results in 10 min.…”

Low specificity of 2 tetanus rapid tests in Cambodia

“…According to authors of other European studies in EU [5] and to Elkharrat, the sensitivity of TQS TM [3], compared to ELISA (with the same positivity threshold of 0.1 IU/mL), was 85.3% and its specificity was 87.2%. Elkharrat, in the second study [4], included 1018 patients admitted to the EU, tested with TQS TM and ELISA, and reported a specificity of 97.5%. Finally, the specificity was 100% for traveler consultations, taking an ELISA threshold of 0.5 IU/mL as cut-off for 100 tested travelers [7].…”

“…It could also account for the good seroconversion in India after only 1 dose of tetanus toxoid [25]. But the test sensitivity was adequate, as reported [1][2][3][4]7,14], showing that sera had been stored correctly, before being used to test RTDT.…”

“…The rapid tetanus diagnostic tests (RTDT) allow quickly assessing the state of immunization against tetanus for patients hospitalized in developed countries especially in the emergency unit (EU), or before gastrointestinal tract surgery [1][2][3][4][5]. They also allow you to check the state of immunization against tetanus for individual going to countries with poorly equipped medical facilities [6,7].…”

Performance of a bedside test for tetanus immunity: results of a cross-sectional study among three EDs in the Netherlands in 2012–2013

“…In contrast to an ELISA assay, the TQS is a bedside test, giving a result within 10 min and easy to perform by a nurse in emergency setting. The manufacturer of the used TQS reported a sensitivity and specificity of 96.4% and 100%, respectively, using a cut-off of ≥0.1 IU/mL for long-term protection 16. Other studies on the Gamma SA TQS and the TQS of two other manufacturers, all having a cut-off of 0.1 IU/mL, found a sensitivity between 55% and 87.1% and a specificity ranging from 97.5% to 100% 13 16–19…”