Prognostic factors affecting deaths from adult tetanus

The objective of this study was to determine prognostic factors related to death from adult tetanus. Fifty-three cases of tetanus, 25 females and 28 males, were treated in C, ukurova University Hospital during 1994 - 2000. The mean age was 46.6 years. Forty-one (77.7%) patients came from rural areas. Most (64.1%) cases had minor trauma, but 19 (35.8%) had deep injuries. The mean incubation period was 11.5 days. Mortality was high (52.8%), caused by cardiac or respiratory failure or complications, and was related to the length of the incubation period. In cases with an incubation period less than or equal to7 days, the mortality rate was 75% ( p 0.07). Mortality was significantly associated with generalised tetanus ( p < 0.05), fever of >= 40 degrees C, tachycardia of > 120 beats / min ( p < 0.05), post-operative tetanus ( p 0.03), and the absence of post-traumatic tetanus vaccination ( p 0.068). Patients who were given tetanus human immunoglobulin or tetanus antiserum ( p > 0.05) had similar outcomes. Patients who were given penicillin had a mortality rate similar to patients who were given metronidazole ( p 0.15). The mortality rate was higher (92%) in patients with severe tetanus than in patients with moderate disease (53%). By multivariate analysis, the time to mortality caused by tetanus, and also the mortality rate, were both related significantly to age and tachycardia.