CLINICAL PROFILE & OUTCOME IN PEDIATRIC TETANUS: EXPERIENCE FROM A TERTIARY CARE PEDIATRIC ICU
Milind S. Tullu*, Keya R. Lihiri**, C.T. Deshmukh***, Basundhara Chennuri ****
Pediatric ICU, Seth G.S. Medical College & KEM Hospital, Mumbai. *, Pediatric ICU, Seth G.S. Medical College & KEM Hospital, Mumbai. **, Pediatric ICU, Seth G.S. Medical College & KEM Hospital, Mumbai. ***, Pediatric ICU, Seth G.S. Medical College & KEM Hospital, Mumbai. ****
Objectives
To study clinical profile of tetanus.
Methods
Following information on tetanus cases was recorded retrospectively: age, sex, stay, mode, severity, duration of spasms, endotracheal (ET) intubation or tracheostomy, mechanical ventilation (MV), complications and outcome. Chi-square test was used for statistical analysis.
Results
Total of 184 patients studied (over 8 years and 10 months; Oct. 1996 - July 2005). Mean age was 3.1 years with sex ratio 1:1.21 (M:F). Duration of stay averaged 18.8 days; survivors - 19.1 while expired patients - 7.4 days. Mode of infection - otogenic 89 (48.4%), post-injury 48 (26.1%) and unknown 47 cases (25.5%). Twenty patients (10.9%) had mild grade while cases with moderate and severe grades were 112 (60.9%) & 52 (28.2%) respectively. 84.2% cases were unimmunised / incompletely immunized. Incubation period (post-injury tetanus) averaged 9.4 days. Period of onset averaged 24.3 hrs. Duration of spasms averaged 5.87 days. Twenty patients underwent ET intubation (average 4.3 days) while 65 underwent tracheostomy (average 13.3 days). Forty patients underwent MV (average duration 8.4 days). Complications: autonomic disturbances (tachycardia / bradycardia - 23.4% and hypo-/ hypertension - 13.6%), LRTI - 23.4% urinary tract infection - 10.3%, gastrointestinal bleed - 5.9%, and paralytic ileus - 5.4%. 55 patients expired (mortality 29.9%). Factors statistically significantly increasing the mortality: severe grade tetanus, post-injury cases, period of onset < 48 hrs, duration of spasms > 3 days, ET intubation, tracheostomy, MV, & autonomic instability.
Conclusions
Otogenic tetanus is the most common mode of tetanus. Mortality increases with increasing grade of tetanus.
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Tullu S M, Lihiri R K, Deshmukh C, Chennuri B.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=317
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