J Korean Soc Emerg Med.  2007 Apr;18(2):143-149.

Clinical Manifestations and Prognostic Factors for Tetanus in the Emergency Department

• Lee HY
• Moon JM
• Min YI
• Chun BJ
• Koh YS
• Lee BG

Abstract

PURPOSE: Tetanus is difficult for emergency physician to diagnosis at an early stage because of its low incidence and atypical initial clinical features. Therefore, we reviewed the clinical features of 54 tetanus cases and attempted to identify factors associated with prognosis in order to improve early diagnosis and treatment.
METHODS
We carried out a retrospective chart review of 54 adult tetanus patients who presented to the ED of Chonnam National University Hospital between January 1996 and December 2005. We collected information on demographics, SAPS II score, clinical feature, course of infection and prognosis. We divided the patients to two groups according to the survival and compared their data statistically.
RESULTS
Fifty four patients, 33 men and 21 women, were included in the study. The mean age was 50.97+/-15.95. The most common initial diagnosis in ED were electrolyte imbalance (n=15), neck and facial dystonia (n=9). The mean incubation period was 10.27+/-6.47 days. The initial SPAS II score 17.29+/-8.45 and the Wood score was 3.12 +/-1.47. Most commonly symptom was dyspnea and dysarthria. Twenty one patients were supported by mechanical ventilation, and the duration of mechanical ventilation was 5.92+/-4.52 days. On multivariate logistic regression analysis, four variables were found to be associated with the prognosis: incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II.
CONCLUSION
Four variables correlated well with the prognosis: Incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II score.

Keyword

Tetanus; Clinical findings; Prognosis

MeSH Terms

Adult
Demography
Diagnosis
Dysarthria
Dyspnea
Dystonia
Early Diagnosis
Emergencies*
Emergency Service, Hospital*
Female
Humans
Incidence
Jeollanam-do
Logistic Models
Male
Neck
Prognosis
Respiration, Artificial
Retrospective Studies
Tetanus*
Wood