6084 Cases of Adult Tetanus from China: A Literature Analysis

Figures & data

Figure 1 Map of case distribution of tetanus in China. This figure illustrates, over nearly 20 years, the distribution of 6084 cases of non-neonatal Tetanus in China from the literature included in this study, in which Hebei, Guangdong, and Shandong corresponded to the largest number of cases with 637, 621, and 568, respectively. Unfortunately, data from Xinjiang, Tibet, Liaoning, Tianjin, Qinghai, Taiwan, Hong Kong, and Macao are missing.

Table 1 General Information About the Cases

Description of Included Tetanus Cases		Number of Cases N	Composition Ratio (%)
Gender N=5925	Male	3950	66.67
	Female	1975	33.33
Place of residence N=580	Rural	514	88.62
	Cities and towns	66	11.38
Career N=645	Farmer	539	83.56
	Worker	20	3.10
	Unemployed	31	4.81
	Other	55	8.53
Average age N=4783	≤30	40	0.84
	31~40	753	15.74
	41~50	2031	42.46
	51~60	1797	37.57
	≥61	162	3.39
Average incubation period N=1511	≤7d	412	27.27
	8~14d	850	56.25
	≥15d	249	16.48
Immunizations N=1200	Passive immunity	26	2.17
	Active immunity	14	1.17%
	No Immunizations	1160	96.66%
Severity grading N=4034	I&I	1217	30.17%
	III&V	2817	69.83%
III, IV N=2817	Critical care group	2028	71.99%
	Normal group	789	28.01%
Normal study group N=2006	I&II	1217	60.67%
	III&V	789	39.33%

Notes: Normal study group was the set of cases from the literature that studied both I&II and III&V. The normal group was the set of III&V cases from the normal study group. The critical care group was the set of cases from the literature that studied only III&V.

Table 2 Causes of Injury

Causes of Injury	Number of Cases (N)	Composition Ratio (%)
Injury caused by Metal and wood	868	54.52
Injuries caused by Sharp objects	144	9.05
Explosive injury	80	5.03
Fall injury	82	5.15
Animal injury	75	4.71
Freezing, burning, and Scalding	37	2.32
Otogenic injury	11	0.69
Injury-derived oral Cavity	27	1.70
Iatrogenic injury	20	1.25
Bruise	92	5.78
Crush injury	34	2.14
Taking intravenous drugs	33	2.07
Others	89	5.59
Total	1592	100

Figure 2 Injury sites and proportion. In this study, 1258 cases recorded the number of injury sites. This figure illustrates the proportion of injury sites such as the lower extremities, the upper extremities, the head and neck, and the trunk. The lower extremities comprised the highest percentage, accounting for 54.35% (699/1258), followed by the upper extremities with 36.47% (469/1286). The head and neck and trunk accounted for a smaller portion, with 7.75% and 1.40%, respectively.

Figure 3 Wound management 24 h after injury and proportion. In this study, wound management 24 h after injury was reported in 775 cases. This figure illustrates the methods and their proportion of wound management 24 h after injury. In total, 87.74% (680/775) of patients did not deal with their wounds 24 h after injury, 9.30% of patients dealt with their wounds by themselves, and 2.96% of patients sought formal wound treatment at a hospital.

Table 3 Approach to Toxin Neutralization

Therapy		Literature (N)	Type of Hospital				Cases (N)	Composition Ratio (%)
			Tertiary Hospital (N)	Secondary Hospitals (N)	Specialized Hospitals (N)	Community Hospitals (N)
TAT	TAT alone	31	22	1	5	1	1163	57.12
	TAT after desensitization	3	1	1	0	0	62	3.05
	TIG after Positive Test	5	3	1	1	0	312	15.32
TIG alone		9	8	0	0	0	270	13.26
TIG+TAT		6	5	0	0	0	229	11.25
Total		54	39	3	5	1	2036	100

Table 4 Therapies of Sedation and Spasmolysis

Therapies	Case (N)	Composition Ratio (%)
Diazepam	369	14.83
Hibernation mixture	333	13.38
Midazolam	175	7.03
Diazepam combined with phenobarbital	345	13.87
Diazepam combined with hibernation combination	278	11.17
Propofol combined with magnesium sulfate	128	5.14
Propofol combined with midazolam	103	4.14
Midazolam in combination with vecuronium bromide	73	2.93
Midazolam in combination with diazepam	56	2.25
Midazolam in combination with remifentanil	58	2.33
Triple therapy	269	10.81
Quadruple therapy	129	5.18
Others	172	6.91
Total	2488	100

Figure 4 Causes of death and proportion. In this study, a total of 4305 cases featured detailed records of patient outcomes. This figure shows the causes of death and their proportion. The leading causes of death were treatment terminated by family members (24.00%), asphyxia due to persistent spasms (24.00%), respiratory failure (21.78%), autonomic dysfunction (11.56%), and others (18.67%).

Table 5 Outcome and Tracheotomy

Group	Cases (N)	Case of T (N)	Rate of T (%)	Death (N)	Mortality (%)
Contrast group	4305	1317	30.60	402	9.34
Contrast tracheotomy group	2749	1317	47.91	222	8.08
Normal study group	1977	387	19.58	224	11.33
Normal study group with T	1376	387	28.13	120	8.72
Critical care group	1269	768	60.52	110	8.67
Critical tracheotomy group	931	768	82.49	75	8.06