Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil.
BACKGROUND
Tetanus is still a significant health hazard in developing countries, with high associated mortality.


OBJECTIVE
Describe the management of patients with severe tetanus in intensive care units (ICUs), in two different periods.


METHODS
ICUs of two general hospitals.


METHODS
Concurrent cohort study.


METHODS
Follow-up of all patients hospitalized with the diagnosis of severe tetanus in the ICUs from October 1981 to March 2001. We collected data prospectively, regarding the site of injury, clinical features, frequent clinical and infectious complications, concomitant illnesses, and mortality. The patients were divided into two groups according to the treatment protocol used; before 1993 and after 1993.


RESULTS
There were 126 patients in group 1 (93 males) with a mean age of 39.0 +/- 18.8 years. There were 110 patients in group 2 (95 males) with a mean age of 48.4+/-17.8 years. Incubation period, onset period, and symptomatic period were higher in group 2 ( P < or = 0.02). The duration of neuromuscular junction blockade, benzodiazepine administration, mechanical ventilation, and ICU stay were longer in group 2, P < 0.001. Infectious complications were more frequent in group 2 ( P < 0.001). The mortality rate in group 1 was 36.5% and in group 2, 18.0% ( P = 0.002). Mortality was directly associated with symptomatic period, acute renal failure cardiac arrest and hypotension, and inversely associated with onset period in the multivariate analyses.


CONCLUSIONS
The reduced mortality in severe accidental tetanus patients in group 2 is probably related to advances in ICU management, despite the higher incidence of infectious complications, which are probably related to the longer ICU stay.
Hospital Nossa Senhora da Conceição, Rio Grande do Sul, Brazil. orlofe@uol.com.br
J S
JS
Brauner
S R Rios
SR
Vieira
T P
TP
Bleck
D000059:Accidents; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013742:Tetanus / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D014947:Wounds and Injuries / Q000150:complications