Mortality Indicators in Tetanus Patients at Fann University Hospital, Department of Infectious and Tropical Diseases, Dakar, Senegal

Abstract

Introduction: In developing countries, tetanus remains an important cause of mortality. Predictive factors of death related to this condition are rarely investigated. Objective: To identify factors associated with death among patients admitted for tetanus at the Department of Infectious and Tropical Diseases (SMIT) of Fann University Hospital, Dakar. Methods: We conducted a retrospective, descriptive, and analytical study including patients hospitalized for tetanus over a 12-year period (2010–2021). Factors associated with mortality were investigated. To compare proportions in each category, bivariate analysis was performed using the chi-square test. Logistic regression was used in multivariate analysis to estimate odds ratios (OR) with 95% confidence intervals (CI). A significance level of α = 5% was considered for statistical significance. Results: A total of 938 cases of tetanus were recorded among 10,948 hospitalized patients, representing a hospital frequency of 8.6%. The mean age was 30.06 years with a sex ratio of 4.27. Comorbidities (19.08%) were mainly hypertension (41%) and diabetes (22%). The mean delay before hospitalization was 3.6 days. The average incubation period was 14.26 days, and the invasion period 2.29 days. The main clinical signs of tetanus observed were trismus (99%), dysphagia (88%), and paroxysms (71%). The primary gateway was cutaneous (79%), and tetanus was generalized in 96% of cases. Patients were mainly classified as stage II according to Mollaret’s classification (82%). More than half of the patients (57%) had a Dakar score between 2 and 3. The mean duration of hospitalization was 11.99 ± 8.99 days. The main complications noted were cardiovascular (18%), respiratory (15%), and infectious (15%). The case fatality rate was 20.47%. In multivariate analysis, five factors were found to be associated with death: invasion < 48 hours (p=0.000); age ≥ 65 years (p=0.002); diabetes (p=0.008); tonic-clonic paroxysms (p=0.004); and occurrence of complications (p=0.000). Conclusion: Risk factors for mortality, namely advanced age and diabetes, are not taken into account in current prognostic classifications of tetanus. It is therefore important to reconsider the parameters used in prognostic scoring systems for tetanus.