Henderson S O, Mody T, Groth D E, Moore J J, Newton E
Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles, USA.
J Emerg Med. 1998 Sep-Oct;16(5):705-8. doi: 10.1016/s0736-4679(98)00082-1.
Traditionally, the literature has described a certain population as at risk for tetanus infection. We reviewed the demographics, clinical presentation, laboratory findings, management, and outcome of all patients who presented to our emergency department (ED) with tetanus in the last 10 years and compared our experience with this classic literature. We performed a retrospective case series review at a large, inner-city medical center; 11 cases of tetanus were identified from 1986 to 1997. Nine male and two female patients were identified with an average age of 45 years. All had an acute injury to the skin, and most (82%) reported having no history of recent immunization. The most common recorded symptoms were trismus and rigidity in the abdomen, neck, back, or extremities. There was only one misdiagnosis in the ED. Three patients died in the hospital, while the other eight were discharged either home or to a rehabilitation facility. In contrast to the classic literature, we found that tetanus in our inner city ED presented in recent immigrants, particularly younger men, over half of whom had received no childhood immunization. Laboratory results and cultures are of little diagnostic value, so timely recognition of the clinical presentation is important.
传统上，文献中将特定人群描述为破伤风感染的高危人群。我们回顾了过去10年中因破伤风前来我院急诊科就诊的所有患者的人口统计学特征、临床表现、实验室检查结果、治疗及转归情况，并将我们的经验与经典文献进行了比较。我们在一家大型市中心医疗中心进行了一项回顾性病例系列研究；1986年至1997年期间共确诊11例破伤风病例。其中男性9例，女性2例，平均年龄45岁。所有患者均有皮肤急性损伤，大多数（82%）报告近期无免疫接种史。最常见的症状是牙关紧闭以及腹部、颈部、背部或四肢僵硬。在急诊科仅有1例误诊。3例患者在医院死亡，另外8例出院回家或转至康复机构。与经典文献不同的是，我们发现市中心急诊科的破伤风患者多为新移民，尤其是年轻男性，其中半数以上未接受过儿童期免疫接种。实验室检查结果和培养对诊断价值不大，因此及时识别临床表现很重要。
