?Refer the patient to his general practitioner to check immunity and the need for Td booster
?Refer the patient to his general practitioner to check immunity and the need for Td booster. Council), by a doctor who was unaware of the TQS result. Results The prevalence of protecting anti\tetanus immunity was 74.1%. Immunity was reduced older individuals Ki8751 and in female individuals. The TQS was a cost\effective tool for patients showing having a tetanus\susceptible wound and regarded as from your vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of individuals by avoiding unneeded treatments, leading to a reduction in the mean cost per patient (10.58/patient with the TQS versus 11.34/individual without). The benefits of the TQS use were significantly higher in individuals <61?years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) Rabbit Polyclonal to HNRNPUL2 of instances and the mean cost per patient reduced to 8.31. Summary In selected individuals, the TQS is definitely a cost\effective tool to evaluate tetanus immunity. An algorithm is definitely proposed for ED assessment of tetanus immunity integrating age and the TQS result. Keywords: tetanus prophylaxis, wound, immunologic test, cost\performance, algorithm Despite the wide availability of an excellent vaccine, tetanus is still a common disease. The estimated incidences in the World Health Business Western region and the USA in the 1990s were 0.8 and 0.16 per million inhabitants, respectively,1,2 but it is believed that there is significant underreporting.3,4 In industrialised countries, most instances of instances happen among non\immunised individuals after an acute wound,4,5,6 and approximately 30C40% of them Ki8751 are fatal.6,7 Tetanus prophylaxis is the cornerstone of disease prevention, and main care providers have an important part to play. The decision whether or not to give prophylaxis currently depends on the characteristics of the wound (low or high risk) and on evaluation of the patient’s immunity based on the vaccination history.8,9 However, vaccination Ki8751 history is unreliable in evaluation of tetanus immunity10,11,12 and thus prophylaxis may be suboptimum in relation to actual immunity. Although overimmunisation raises costs and risks of secondary effects unnecessarily, underimmunisation puts the patient at risk of contracting tetanus. Recently, an immunochromatography\centered test (Ttanos Quick Stick; TQS) has been marketed, making bedside semiquantitative evaluation of anti\tetanus immunity possible. We as well as others have shown the TQS is a reliable and effective tool for the evaluation of immunity to tetanus in the emergency division (ED).10,13,14 To our knowledge, however, no costCbenefit analysis of TQS use offers previously been performed. This multicentre study was designed to investigate the cost\effectiveness of the TQS for the choice of tetanus prophylaxis for individuals showing in the ED having a wound. Because anti\tetanus immunity offers previously been shown to become related to age, sex, and birthplace,10,15,16 these demographic features were included in the analysis. Finally, taking into account these results as well as those of our earlier study,10 we were able to define the place of the TQS inside a altered algorithm for management of patients showing to the ED having a wound. Methods Survey design This multicentre, prospective, double blind study was carried out in five EDs (three university or college\affiliated private hospitals and two local hospitals) located in urban or rural areas of the three regions of Belgium (Brussels, Flanders and Wallonia) (table 1?1). Table 1?Description of investigative EDs and study group are ubiquitous, exposure is frequent and difficult to prevent. Passive or active immunisation by immunoglobulin or vaccine, respectively, is the most efficient way to prevent the disease. The increased number of cases of tetanus Ki8751 observed among geriatric.