Payesh
2010; 9: 29-37
Accepted for publication: 29 July 2008
[EPub a head of print-7 March 2010]

Objective(s): Injuries and realed wounds are one of the most common causes of admission in emergency departments. In this study the national protocol for tetanus prevention is compared with Eliza as the golden standard for detecting immunity of person.
Methods: In a cross sectional study 200 individuals with wound admitted at Imam Hussein hospital (a teaching hospital in Tehran, Iran) were assessed and questionnaires were filled in based on physician decision as protocol recommended and also the result of Eliza. Agreement of physician decision and Eliza result has been evaluated by Kappa index. Sensitivity, specificity, predictive values, likelihood ratios and accuracy were also detected for different methods of vaccine and immunoglobulin administration.
Results: Immunoglobulin was administered for 30 percent of persons and vaccine for 23.5 percent. Kappa index for agreement between protocol administration and real administration in emergency department was 0.307 for immunoglobulin and 0.136 for vaccine (p<0.05). It was 0.081 (P>0.05) and 0.199 (P<0.001) for agreement of protocol administration and Eliza and 0.008 and 0.054 (P>0.05) for agreement of administration in emergency depertment and Eliza respectively.
For immunoglobuline sensitivity was 0.33, specificity 0.24, positive predictive value 0.25, negative predictive value 0.82, positive likelihood ratio 1.38, negative likelihood ratio 0.88 and accuracy 0.68. For vaccine sensitivity was 0.82, specificity 0.52, positive predictive value 0.29, negative predictive value 0.92, positive likelihood ratio 2.2, negative likelihood ratio 0.35 and accuracy 0.58.
Conclusion: The sensitivity, specificity, predictive value, likelihood ratio and accuracy for national protocol are not enough for using in emergency department. It seems that there is need for another reliable and valid substitute method.