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Two others (7%) conformed to the CGP guidelines (HC recommendations for tetanus prone wounds only).
More than half of GPs have adopted the more restrictive CGP-guideline, which limits T-PEP to tetanus prone wounds.
The Dutch College of General Practitioners (CGP) states to use T-PEP only in tetanus prone wounds.
Another 36% of the guidelines included the CGP suggestion to restrict the T-PEP use to tetanus prone wounds only, which might lead to under immunisation.
However the TQS cost was higher than current practice for non-tetanus prone wounds or when lower prophylaxis costs were explored; and in those cases TQS was associated with high ICER.
Of the guidelines described in the survey responses, 28% (n = 23; EDs 41%, GPs 21%) were consistent with the HC-recommendations, 36% (n = 29; EDs 7%, GPs 52%) adhered to the guidelines of the College of GPs (CGP), which restricts the use of T-PEP to tetanus prone wounds but for these wounds is in line with the recommendations of the HC.
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The CGP guideline does not prescribe T-PEP in case of a non-tetanus prone wound.
However, it is more expensive in patients with non-tetanus-prone wounds.
Those replying yes received no prophylaxis; those replying no received a booster and a TIG injection in the case of tetanus-prone wounds and only a booster in the case of no tetanus-prone wounds.
However, for the non-tetanus-prone wounds cohort, the "TQS" strategy cost more than "Medical Interview" while being more effective.
Since wound type determines ED care and has an impact on tetanus risk, we conducted a sub-analysis on tetanus-prone and non-tetanus-prone wounds.
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