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

中文翻译：

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破伤风免疫的即时检测：系统评价和荟萃分析

背景 目前对开放性伤口患者进行破伤风预防管理的护理标准可能会导致过度治疗和不必要的费用。已开发出称为破伤风快速棒 (TQS) 的即时免疫层析测试，用于定性测量破伤风免疫球蛋白水平。多项研究提倡将它们用于 ED。我们旨在评估 TQS 的诊断准确性和成本效益，以评估其在一线急救护理中的相关性。方法 按照系统评价和元分析 (PRISMA) 指南的首选报告项目进行系统评价。在 MEDLINE、Embase、Global Health、The Health Management Information Consortium 和 The Cochrane Library 中进行了文献检索。如果报告了 TQS 的敏感性、特异性或成本效益，则研究符合条件。至少有两名作者独立评估和提取每项研究的数据。进行荟萃分析以评估 TQS 的汇总敏感性和特异性估计。结果 12 项研究适合纳入（n=1 662 865 名参与者）：1 项建模和 11 项前瞻性观察性队列研究。八项研究评估了诊断准确性；敏感性的总结估计为 90%（95% CI，89% 至 90%），特异性为 97%（95% CI，95% 至 100%）。由于减少了不必要的破伤风疫苗和免疫球蛋白给药，六项研究调查了成本效益，报告使用 TQS 代替当前的疫苗接种历史方法时医疗保健成本较低。根据当前的 NHS 供应链数据，使用 TQS 可以为每位易患破伤风的患者节省 173.05 英镑。结论 TQS 如果与破伤风易发伤口患者的疫苗接种史结合使用，可以最大程度地节省成本。建议在 ED 中实施 TQS 之前进行质量保证流程。所有与研究相关的数据都包含在文章中或作为补充信息上传。