Table 1 Clinical characteristics and outcomes of non-neonatal tetanus patients seen in a tertiary hospital in the Philippines

Demographics

Age (median, range)

37.5 (2–75)

47 (20–75)

8 (2–18)

Sex

 Male

102 (74%)

72 (73%)

30 (75%)

 Female

36 (26%)

26 (27%)

10 (25%)

Place of Residence

 National Capital Region (NCR)

36 (41%)

30 (46%)

6 (26%)

 Region III

8 (9%)

6 (9%)

2 (9%)

 CALABARZON

41 (47%)

26 (40%)

15 (65%)

 Others

3 (3%)

3 (5%)

0 (0%)

 No available data

50

Risk Factors

Comorbidities

 Malignancy

16 (18%)

16 (23%)

0 (0%)

 Hypertension or other cardiovascular disease

12 (13%)

12 (17%)

0 (0%)

 Pulmonary disease

11 (12%)

10 (14%)

1 (5%)

 Diabetes mellitus or other endocrine disease

8 (9%)

8 (11%)

0 (0%)

 Stroke or other neurologic disease

6 (7%)

6 (9%)

0 (0%)

 Renal disease

2 (2%)

2 (3%)

0 (0%)

 Hepatic disease

1 (1%)

1 (1%)

0 (0%)

 No available data

48

Vaccination Status

-

-

-

Clinical Presentation

Mode of Infection

 Post-traumatic

45 (49%)

32 (46%)

13 (59%)

 Post-infectious

35 (38%)

29 (42%)

6 (27%)

 Post-surgical

3 (3%)

3 (4%)

0 (0%)

 Unknown

8 (9%)

5 (7%)

3 (14%)

 No available data

47

Type of Injury Sustained

 Puncture wound

29 (32%)

24 (35%)

5 (23%)

 Abrasion

7 (8%)

4 (6%)

3 (14%)

 Head and neck infection

8 (9%)

1 (1%)

7 (32%)

 Operative wound

3 (3%)

3 (4%)

0 (0%)

 Dental manipulation

2 (2%)

2 (3%)

0 (0%)

 Animal bite

1 (1%)

1 (1%)

0 (0%)

 Burn

1 (1%)

1 (1%)

0 (0%)

 Foreign body aspiration or insertion

1 (1%)

1 (1%)

0 (0%)

 Others

39 (43%)

32 (46%)

7 (32%)

 No available data

47

Site of Injury or Infection

 Lower extremities

38 (42%)

33 (48%)

5 (23%)

 Head

21 (23%)

11 (16%)

10 (45%)

 Trunk

15 (16%)

13 (19%)

2 (9%)

 Upper extremities

4 (4%)

2 (3%)

2 (9%)

 Perineal area

3 (3%)

3 (4%)

0 (0%)

 Others

10 (11%)

7 (10%)

3 (14%)

 No available data

47

Interval from Trauma to First Symptom, in days (median, range)

7 (0-176)

8 (0-176)

3.5 (1–12)

Interval from First Symptom to Spasm, in days (median, range)

1 (0–28)

1 (0–28)

1 (0–3)

Initial or Presenting Symptom

 Trismus

55 (65%)

43 (67%)

12 (60%)

 Dysphagia

9 (11%)

8 (13%)

1 (5%)

 Spasms

9 (11%)

6 (9%)

3 (15%)

 Rigidity

3 (4%)

1 (2%)

2 (10%)

 Neck stiffness

8 (10%)

6 (9%)

2 (10%)

 No available data

54

Symptoms

 Trismus

83 (99%)

63 (98%)

20 (100%)

 Spasms

72 (86%)

53 (83%)

19 (95%)

 Dysphagia

49 (58%)

41 (64%)

8 (40%)

 Rigidity

47 (56%)

36 (56%)

11 (55%)

 Neck stiffness

34 (40%)

27 (42%)

7 (35%)

 Risus sardonicus

17 (20%)

12 (19%)

5 (25%)

 Opisthotonos

16 (19%)

9 (14%)

7 (35%)

 Spasticity

11 (13%)

5 (8%)

6 (30%)

 No available data

54

Number of Body Segments with Spasms (median, range)

2 (0–4)

1 (0–4)

2 (0–4)

Body Segments Affected with Spasms

 Head

19 (23%)

15 (23%)

4 (20%)

 Trunk, including abdomen

58 (69%)

44 (69%)

14 (70%)

 Arms

27 (32%)

17 (27%)

10 (50%)

 Legs

39 (46%)

27 (42%)

12 (60%)

 No available data

54

Type of Tetanus

 Generalized

113 (86%)

81 (85%)

32 (86%)

1 (3%)

 Localized

7 (5%)

6 (6%)

 No available data

6

Stage

 I

6 (5%)

5 (5%)

1 (3%)

 II

39 (30%)

32 (34%)

7 (19%)

 III

76 (58%)

49 (52%)

27 (73%)

 No available data

6

Management

Tetanus Antitoxin (ATS) Dose, in units (median, range)

10,000 (1,000–40,000)

10,000 (3,000–40,000)

3,000 (1,000–10,000)

Route of Administration of ATS

 IM alone

66 (80%)

49 (79%)

17 (85%)

 IM + wound infiltration

11 (13%)

9 (15%)

2 (10%)

 Not specified

5 (6%)

4 (6%)

1 (5%)

 No available data

56

TeAna Dose, in ml

0.5

0.5

0.5

Medications

 Metronidazole

91 (100%)

71 (100%)

20 (100%)

 Diazepam

85 (93%)

69 (97%)

16 (80%)

 Midazolam

44 (48%)

25 (35%)

19 (95%)

 Rocuronium

25 (27%)

8 (11%)

17 (85%)

 Magnesium sulfate

42 (46%)

36 (51%)

6 (30%)

 Baclofen

53 (58%)

53 (75%)

0 (0%)

 Carbamazepine

20 (22%)

20 (28%)

0 (0%)

 No available data

47

Primary Service

 Adult Neurology

89 (64%)

89 (91%)

0 (0%)

 Surgery

4 (3%)

3 (3%)

1 (2%)

 Pediatrics

39 (28%)

0 (0%)

39 (98%)

Services Onboard

 ORL

76 (90%)

56 (88%)

20 (100%)

 General Medicine

45 (54%)

45 (70%)

0 (0%)

 IDS

74 (88%)

58 (91%)

16 (80%)

 Pulmonology

32 (38%)

32 (50%)

0 (0%)

 Cardiology

20 (24%)

8 (13%)

12 (60%)

 Nephrology

22 (26%)

20 (31%)

2 (10%)

 Medical Oncology

7 (8%)

7 (11%)

0 (0%)

 Surgery

34 (40%)

30 (47%)

4 (20%)

 Rehabilitation Medicine

40 (48%)

29 (45%)

11 (55%)

Number of Services Onboard (median, range)

6 (2–13)

6 (2–13)

4 (3–8)

Clinical Course

Duration of Hospital Stay, in days (median, range)

19 (0-198)

19 (0-198)

20 (0–56)

Duration of ICU Stay, in days (median, range)

10 (0–49)

11.5 (0–49)

6 (0–47)

Interval from Admission until Tracheostomy, in days (median, range)

0 (0-169)

0 (0-169)

0 (0–1)

Number of Complications During Admission (median, range)

1 (0–7)

1 (0–7)

2 (0–5)

Complications

 Pneumonia

54 (59%)

43 (62%)

11 (50%)

 Catheter-associated urinary tract infection

10 (11%)

5 (7%)

5 (23%)

 Bacteremia

12 (13%)

10 (14%)

2 (9%)

 Catheter-related bloodstream infection

3 (3%)

2 (3%)

1 (5%)

 Acute kidney injury from rhabdomyolysis

6 (7%)

5 (7%)

1 (5%)

 Acute kidney injury from other causes

11 (12%)

10 (14%)

1 (5%)

 Pulmonary embolism or other embolic events

3 (3%)

3 (4%)

0 (0%)

 Bleeding from any cause

13 (14%)

8 (12%)

5 (23%)

 Pressure ulcers

12 (13%)

6 (9%)

6 (27%)

 No available data

47

Presence of Autonomic Dysfunction

 Yes

21 (23%)

14 (20%)

7 (32%)

 No

71 (77%)

56 (80%)

15 (68%)

 No available data

46

Outcome

Outcome of Admission

 Discharged

78 (67%)

61 (69%)

17 (61%)

 Expired

34 (29%)

24 (27%)

10 (36%)

 Home against medical advice

5 (4%)

4 (4%)

1 (4%)

 No available data

21

Cause of Mortality, If Applicable

 Septic shock

9 (26%)

8 (33%)

1 (10%)

 Cardiogenic shock

3 (9%)

3 (13%)

0 (0%)

 Obstructive shock

1 (3%)

1 (4%)

0 (0%)

 Respiratory failure

6 (18%)

2 (8%)

4 (40%)

 Fatal arrhythmia

6 (18%)

4 (17%)

2 (20%)

 Others

3 (9%)

2 (8%)

1 (10%)

 Unspecified

6 (18%)

4 (17%)

2 (20%)