Alagappan Kumar, Pulido Gina, Caldwell Juliet, Abrahamian Frederick M
Department of Emergency Medicine, North Shore, Long Island Jewish Health System, New Hyde Park, NY, USA.
South Med J. 2006 Mar;99(3):234-8. doi: 10.1097/01.smj.0000202705.51101.e3.
The Advisory Committee of Immunization Practice (ACIP) has established guidelines for tetanus immunoprophylaxis for patients who present to the emergency department (ED) with wounds. We assessed physician compliance with these guidelines for admitted versus discharged patients. The data in this study comes from one institution involved in a recently published prospective observational study that was conducted at 5 university-affiliated hospitals. Of 400 patients enrolled, 65/397 (16.3%) did not receive tetanus immunoprophylaxis in accordance with ACIP guidelines. Emergency physicians were less likely to adhere to the ACIP tetanus guidelines when admitting patients to the hospital. Of patients discharged, (89%), 292 of 325 were treated in accordance with ACIP guidelines compared with 39/71 (55%) of admitted patients (P < 0.001). Admitted patients were also more likely to sustain tetanus-prone wounds. Despite a propensity to present with tetanus-prone wounds, patients admitted to the hospital were less likely to receive tetanus immunoprophylaxis in accordance with ACIP guidelines.
免疫实践咨询委员会（ACIP）已制定针对因伤口前往急诊科（ED）就诊患者的破伤风免疫预防指南。我们评估了医生对这些指南在住院患者和出院患者中的遵循情况。本研究中的数据来自一家参与了近期在5家大学附属医院开展的前瞻性观察性研究的机构。在纳入的400例患者中，65/397（16.3%）未按照ACIP指南接受破伤风免疫预防。当收治患者入院时，急诊医生不太可能遵循ACIP破伤风指南。在出院患者中，325例中有292例（89%）按照ACIP指南接受了治疗，而住院患者中这一比例为39/71（55%）（P<0.001）。住院患者也更有可能出现易患破伤风的伤口。尽管倾向于出现易患破伤风的伤口，但住院患者按照ACIP指南接受破伤风免疫预防的可能性较小。
