Tetanus patient profiles and factors affecting clinical outcomes at Dr. Soedono general hospital, Madiun in 2019-2020

Abstract

Introduction: Tetanus is a disease that can be diagnosed clinically. However, there is a lack of research data on tetanus patients and their clinical outcomes, especially in adult tetanus patients in Indonesia. This study aims to determine the factors that influence the outcome of tetanus patients. Method: A cross-sectional study was performed from May to June 2021 at Dr. Soedono Madiun General Hospital. Subjects were recruited by total sampling. The data that will be taken in this study are gender, age, immunization history, incubation period, onset, port of entry, Philips score, and clinical outcomes of patients. Result: Were 112 patients diagnosed with tetanus at Dr. Soedono General Hospital from January 2019 to December 2020. The male subjects outnumbered female subjects by 81.3%. The youngest subject was 19 years old, and the oldest was 81 years old. The tetanus immunization status showed that 2 patients were known to be fully immunized, 21 were not fully immunized, and 89 (79.5%) had unknown immunization status. This study showed that the port of entry of the wound is most often the entry point for tetanus in the inferior extremity of 72 patients (64.3%). Most onset occurred in 1-7 days, with a mean onset for generalized tetanus was 2.3 ± 1.8 days. The mean incubation period for the appearance of tetanus symptoms in this study was 9.4 ± 5.6 days. The most common comorbid disease in this study was diabetes mellitus (11.6%). This study’s clinical outcome of tetanus showed that 74 patients (66.1%) had improved, while 38 patients (33.9%) died during treatment. Discussion: This study’s most common port of entry was on the inferior extremities. This lower limb predominance as the port of entry could be explained by the fact that C. tetani exists in soil; hence, any lower limb injury would be open to contamination and infection by this organism. Based on the Dakar and Phillips score system, tetanus has a worse prognosis when there is a faster incubation period, faster onset, more proximal port of entry location, immunization status, comorbidities and signs of muscle spasm, fever, and tachycardia are obtained. Conclusion: In this study, tetanus still has a high mortality rate. Male gender, age over 45, a moderate to severe disease degree (considering a relatively short incubation time, short onset period, and unknown immunization status) are a few factors that may affect this high mortality rate.