Clinical profile and prognostic factors of mortality among adult tetanus patients in Cagayan Valley Medical Center: A crosssectional study

ABSTRACT

Introduction@#Tetanus remains a public health threat in developing countries and is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in the Philippines, hence, the study was conducted to determine the demographic, clinical profile, and prognostic factors that are associated with mortality among adult tetanus patients admitted in Cagayan Valley Medical Center (CVMC).@*Methods@#This is a retrospective study of patients who presented with a clinical diagnosis of tetanus, above 19 years old at CVMC between September 1, 2012 to October 31, 2018.@*Results@#A total of 194 patients were studied. The male to female ratio was 111.Majority of patients were aged > 40 years (68.56%), rural dwellers (88.66%), farmers (84.02%) and males (91.75%). Only 3.09% of patients had prior tetanus immunization. Most common antecedent injury is trauma (84.53%), most commonly due to punctured wounds (63.40%). All patients had generalized tetanus, and majority were admitted in moderate grade (68.56%). Most common manifestations were trismus (92.78%), spasms (84.02%), dysphagia (80.93%) and rigidity (68.04%). Complication rate is 64.43%. Mortality rate is 38.66%. Most common cause of death is acute respiratory failure. Poor prognostic factors determined by univariate analysis were age more than 40 years (OR=2.24, p-value=0.0160), incubation period less than seven days (OR=2.65, p-value= 0.0027), period of onset less than three days (OR=2.52, p-value=0.0150) , severity of disease (OR=17.35, p-value=<0.0001), need for ventilatory support (OR=22.20, p-value=<0.0001) and presence of complications (OR=2.96, p-value= 0.0013). In multivariate analysis, only need for ventilatory support is associated with mortality (OR=31.57, p-value=0.000).@*Conclusion@#Mortality rate of adult tetanus in Cagayan Valley Medical Center is high. Therefore, health education is highly encouraged to promote awareness, specifically in immunization and basic wound management.