Author(s): Sidhartha SS, Peter JV, Subhash HS, Cherian M, Jeyaseelan L
INTRODUCTION: Tetanus in adults continues to be a major public health problem in developing countries. Prognosis in tetanus is largely dependent on the various clinical characteristics. This study was carried out to develop a clinical prognostic scoring system according to the natural progression of the disease and to assess its ability to predict the need for specific therapeutic interventions and mortality. MATERIALS AND METHODS: Sixty-five patients were studied, 15 prospectively and 50 retrospectively with an age range between 12 to 70 years. RESULTS: The incubation period was > 7 days in 26 patients (40%), <24 hours in 25 patients (38%), 53 patients (81.5%) had generalized rigidity and 19 (29%) had autonomic dysfunction. Forty-eight (74%) patients needed tracheostomy and 29 (45%) needed mechanical ventilation. The overall mortality was 34%. There was a linear correlation between the grade of tetanus and mortality, (score <2 = 1%, <4 = 3%, >5 = 26%), need for Tracheostomy, (score <4 = 18%, 5 = 26%, >5 = 47%), need for ventilation (scores <4 = 6-8%, 5 = 12%, >5 = 34%), diazepam requirement (scores <4 mean 1500 mg, >5 mean 4000-5000 mg) and duration of ICU stay (score <4 mean of 1 week, > 5 mean 2 to 3 weeks. The overall sensitivity and specificity was 61% and 87% respectively for severe tetanus (score > 6). Multivariate logistic regression analysis showed patients above the age of 50 years (P = 0.003) and need for mechanical ventilation (P = 0.009) were significantly associated with high mortality. DISCUSSION: Prognostication of tetanus with this system was better in comparison with the existing scoring systems in predicting mortality and the need for specific therapeutic interventions. CONCLUSION: The proposed scoring system is a good indicator of the severity of tetanus and use of this system will help in identifying high-risk patients enabling early therapeuticintervention.