E. O. Pierce1, J. B. Brock1, A. V. Dukes1, C. Stevens1, T. E. Robertson1 1University Of Mississippi,Surgery,Jackson, MS, USA
Introduction:
Tetanus has become an uncommon disease in developed countries due to vaccinations. Appropriate tetanus prophylaxis continues to be a problem, allowing for tetanus cases to still occur in the United States. The Advisory Committee on Immunization Practices (ACIP) recommends that tetanus-prone wounds be given prophylaxis. Tetanus-prone wounds are contaminated wounds, including abrasions, as well as puncture wounds, avulsions, missiles, crushes, burns or frostbite. The purpose of this study was to determine if there are missed tetanus vaccination opportunities at a level one academic trauma center.
Methods:
A retrospective chart review was performed on severe trauma patients between July 2012 and June 2014. All leveled trauma patients ages 18 and older who met the Trauma Quality Improvement Program (TQIP) inclusion criteria were reviewed. These patients were compared to patients given tetanus prophylaxis in our institution. The results were further evaluated by age of patient, type of trauma (blunt, penetrating, burns), and type of presentation (transfer from outside hospital, direct presentation from the scene).
Results:
4,319 patients ages 18 and over presented as leveled traumas during the given time period. Of these, 30.2% received the recommended tetanus prophylaxis. 571 of these leveled trauma patients (13%) were greater than 65 years of age and 19.6% of these patients received tetanus prophylaxis. There were 3,314 blunt traumas and 27.8% of these received prophylaxes. There were 945 penetrating traumas and 37.7% of these received prophylaxes. There were 36 burns and 58.3% of these received prophylaxes. 1,586 patients were transferred from outside hospitals and 2,667 were brought in directly from the trauma scene. 13.4% of transfers received prophylaxis and 39.9% of direct responses received prophylaxis
Conclusion:
A large number of trauma patients are not receiving tetanus prophylaxis despite presenting with tetanus-prone wounds. Immunization status could not be gleaned from this retrospective chart review, but most adults after major trauma are unable to recall their immunization status. Patients who were transferred from another center may have received immunization there, but even primary response teams from the scene had only a 40% immunization rate. All penetrating wounds meet vaccination criteria and blunt may or may not include a tetanus prone wound, but considering the risks and benefits of vaccination, it would be reasonable to have all traumas receive tetanus prophylaxis. Major blunt trauma rarely presents without an abrasion. Further research will include provider education and systems improvements to determine the best mechanism to increase vaccination rates. There are missed tetanus vaccination opportunities at this level one academic trauma center.