Head and Neck Symptoms as Predictors of Outcome in Tetanus Patients

  • Angeli C. Carlos-Hiceta, MD Department of Otorhinolaryngology Philippine General Hospital University of the Philippines Manila
  • Ryner Jose D. Carrillo, MD, MSc Department of Anatomy, College of Medicine, University of the Philippines Manila; Department of Otorhinolaryngology College of Medicine – Philippine General Hospital University of the Philippines Manila
  • Jose Florencio F. Lapeña, Jr., MA, MD Department of Otorhinolaryngology College of Medicine – Philippine General Hospital University of the Philippines Manila https://orcid.org/0000-0002-5794-1878
Keywords: tetanus, head and neck symptoms, outcome, predictors of outcome, trismus, neck pain/ rigidity, tracheotomy

Abstract

ABSTRACT

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients.

Methods:
Design: Retrospective Cohort Study
Setting: Tertiary National University Hospital
Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed.

Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality.

Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.

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Published
2020-12-01
How to Cite
1.
Carlos-Hiceta A, Carrillo RJ, Lapeña JF. Head and Neck Symptoms as Predictors of Outcome in Tetanus Patients. Philipp J Otolaryngol Head Neck Surg [Internet]. 2020Dec.1 [cited 2021Jan.27];35(2):32. Available from: https://pjohns.pso-hns.org/index.php/pjohns/article/view/1519