Ongoing tetanus prophylaxis of injured patients in five hospital emergency rooms

The adequacy of antitetanus prophylaxis given in five hospital emergency rooms to 729 individuals up to 15 years, suffering from different types of injuries, was evaluated retrospectively using vaccinal data retrieved from a terminal of the computerized files of the City of Milan Health Authority operated in our Department. Comparing the recommended treatment (according to the guidelines issued by the Italian Ministry of Health, 1982) with that actually obtained, we have classified the subjects into three ("correctly treated", "undertreated" and "overtreated") groups. Correct treatment ranged from 70 to 90 percent, undertreatment from 4 to 6 percent, and overtreatment from 8 to 26 percent at the different hospitals. Undertreatment was most likely in incompletely immunized patients (having previously received one or two doses of tetanus toxoid), while overtreatment was much more common in patients fully immunized. By comparison, 545 patients sixteen and older, whose immunization history was unknown, were evaluated to obtain information about the behaviour adopted by the physicians in the same circumstances. Grouping the subjects by age we found that in two hospitals the highest proportion of untreated (18 and 25 percent) belonged to the group of individuals more prone to the disease (over 60 years of age). Compliance with the Ministerial Instructions would have led to an increase in the use of tetanus toxoid and to a decrease in the use of human immunoglobulin, improving the quality of prevention without adding to its cost.