Tetanus prophylaxis and accidental wounds.

Of 400 consecutive patients who had wounds treated in the Accident Department, 200 remembered receiving either booster injections or a full course of tetanus toxoid in the last 10 years. During this period, 182 patients received their initial toxoid injection in association with treatment of a wound in an accident department. Only 71 (38%) of these patients attended for a full course of injections. From our assessment of the wounds and the patient's anti-tetanus immunity, 79 patients (20%) were considered to be at risk of developing tetanus. By further considering the time interval elapsed between injury and treatment, a 'high risk' group of 13 patients (3%) was recognised. It is recommended that the use of human immunoglobulin should be reserved for the 'high risk' group, and that the remainder of the 'at-risk' patients should receive penicillin prophylaxis only.