In-Hospital Mortality among Patients of Severe Adult Tetanus Presenting with bad Prognostic Factors: A Tertiary Care Hospital Experience

Abstract

Background: Tetanus caused by clostridium tetani, despite being a preventable disease, is still posing a significant health hazard to developing countries like Pakistan. Objective: To determine in-hospital mortality among patients of severe adult tetanus presenting with bad prognostic factors.Material and Methods: This cross-sectional study was conducted at the Department of Medicine, Medical Teaching Institution Lady Reading Hospital, Peshawar, Pakistan from July 13, 2017, to January 13, 2018, on 176 patients. All severe adult tetanus patients as per Ablett Classification with bad prognostic factors (incubation period <7 days, persistent fever >40o C, persistent tachycardia of >120/min, and no history of post-exposure prophylaxis) were included in the study. Patients with compromised renal functions (urea >108 mg/dl, reduced urine output <50 ml/hr) and already diagnosed neuromuscular junction disorders were excluded from the study. Written informed consent was obtained and patients were enrolled in the study. All patients were immediately worked up with detailed history and clinical examinations and were managed as per ICU protocols and followed within the hospital for mortality.Results: Mean age of study participants was 47±10.27 years. The majority of study subjects were males (n=102, 58%), un-immunized (n=88, 50%) or partially immunized (n=26, 15%), socioeconomically poor (n=84, 48%), illiterate (n=82, 47%) and from urban areas (n=114, 65%). In-hospital mortality was recorded in 109 (62%) of the study subjects. In hospital mortality was recorded highest in patients with an age range of 41-65 years (n=70/109, 64.22%), males (n=63/109, 57.8%), unimmunized (n=55/109, 50.45%), poor (n=52/109, 47.7%), illiterate (n=51/109, 46.78%) and urban (n=71/109, 65.14%). Conclusion: In-hospital mortality was high in patients with severe adult tetanus presenting with bad prognostic factors.Keywords: Clostridium tetani, Hospital Mortality, Severe adult tetanus, Tetanus, Tetanus Antitoxin, Tetanus Toxoid, Trismus, Prognostic Factors.