Table 1A. Prognostic Scoring Systems in Tetanus Dakar Score
|
Prognostic Factor |
Score 1 |
Score 0
|
|
|
Incubation period |
< 7 days |
≥ 7 days or unknown |
|
|
Period of onset |
< 2 days |
≥ 2 days |
|
|
Entry site |
Umbilicus, burn, uterine, open fracture, surgical wound, IM injection |
All others plus unknown |
|
|
Spasms |
Present |
Absent |
|
|
Fever |
> 38.4oC |
< 38.4oC |
|
|
Tachycardia |
Adult > 120 beats/min Neonate > 150 beats/min |
Adult < 120 beats/min Neonate < 150 beats/min |
|
|
Total Score |
|
|
|
|
Factor |
Score |
|
Incubation Time |
|
|
< 48 hours |
5 |
|
2-5 days |
4 |
|
5-10 days |
3 |
|
10-14 days |
2 |
|
> 14 days |
1 |
|
Site of infection |
|
|
Internal and umbilical |
5 |
|
Head, neck, and body wall |
4 |
|
Peripheral proximal |
3 |
|
Peripheral distal |
2 |
|
Unknown |
1 |
|
State of protection |
|
|
None |
10 |
|
Possibly some or maternal immunisation in neonatal patients |
8 |
|
Protected > 10 years ago |
4 |
|
Protected < 10 years ago |
2 |
|
Complete protection |
0 |
|
Complicating factors |
|
|
Injury or life threatening illness |
10 |
|
Severe injury or illness not immediately life threatening |
8 |
|
Injury or non life threatening illness |
4 |
|
Minor injury or illness |
2 |
|
ASA Grade 1 |
0 |
|
Total Score |
|
Table 1C. Prognostic Scoring Systems in Tetanus, Grading of Severity [Urwadia 1994]
|
Grade 1 (Mild): |
Mild to moderate trismus, general increased tone, no respiratory distress, no spasms, and no dysphagia |
|
Grade 2 (Moderate): |
Moderate trismus, marked rigidity, short lasting spasms, tachypnoea ≥ 35minute-1, mild dysphagia. |
|
Grade Three (Severe): |
Severe trismus, generalised increased tone, reflex spontaneous or prolonged spasms, respiratory distress with tachypnoea ≥ 40minute-1, apnoeic spells, severe dysphagia, tachycardia ≥120 minute-1, moderate increase in autonomic nervous system dysfunction. |
|
Grade Four (Very Severe): |
Features of Grade III, plus severe autonomic dysfunction, persistent labile blood pressure and pulse rate. |
Table 2. Vaccination Schedules [Peter 1995].
|
Vaccine |
Children under 7 years |
|
1-DPT |
6-8 weeks |
|
2-DPT |
4-8 weeks after previous dose |
|
3-DPT |
4-8 weeks after previous dose |
|
4-DPT |
1 year after previous dose |
|
Booster-DPT |
4-6 years of age |
|
|
Adults and children not previously vaccinated |
|
1-Td |
At presentation |
|
2-Td |
4-8 weeks after previous dose |
|
3-Td |
6 months - 1 year after previous dose |
|
Booster- Td |
Every 10 years after previous dose |
|
|
Pregnant women previously vaccinated |
|
Booster- TT |
During first six months of pregnancy |
|
|
Pregnant women not previously vaccinated |
|
1-TT |
First encounter during pregnancy |
|
2-TT |
4 weeks after previous dose |
Abbreviations: DPT, diphtheria and tetanus toxoid and pertussis absorbed; Td tetanus and reduced-dose diphtheria toxoids absorbed; TT, tetanus toxoid