Intensive care in tetanus: management, complications, and mortality in 100 cases

One hundred cases of tetanus were treated in the intensive care unit of Leeds General Infirmary during during 1961--1977. In 90 patients disease was severe enough to require paralysis and artificial ventilation; a further three needed tracheostomy but not paralysis; and in seven the condition was mild, requiring sedation only. Ten patients died, but all deaths were attributable to complications of treatment rather than to the disease itself and were theoretically avoidable. No evidence of permanent neurological damage from tetanus was found. In 65 patients a wound was the source of infection, most of which were minor, often receiving no medical attention. In five patients the source was probably varicose ulcers of the leg. Such patients, if lacking immunity, are at risk, particularly when farming or gardening. Only two patients had received a full course of tetanus toxoid, in one case eight years and in the other three years before injury; neither received a booster dose at the time of injury and in the second tetanus was mild. Of the 35 patients who did seek medical attention at the time of wounding, 21 received prophylactic antibiotics and 25 tetanus toxoid, but none received equine or human antitetanus serum. Early resort to tracheostomy and paralysis in severe tetanus resulted in a favourable mortality of 10% in the series. To implement such a policy full intensive-care facilities, with a trained nurse to care for each patient, must be available at all times.