The Reliability of Anamnestic Data in the Management of Clostridium Tetani Infection in Elderly

Abstract

Background: Tetanus infection remains a significant complication of wounds. Because most tetanus treatment guidelines rely on anamnestic data collected directly from patients, the congruence between anamnesis and laboratory evidence must be verified, especially in the elderly population.Aim: Assess, in both the geriatric population (>65) and the non-geriatric one, the reliability of anamnestic data for managing patients with tetanus-risk wounds, identified categories of populations most exposed to non-vaccination coverage, and assessed the agreement of the Tetanos Quick Stick (TQS) results with the therapy performed (administration of tetanus vaccine or immunoglobulin).Methods: In this retrospective single-center observational study, patients were asked their immunization status against tetanus vaccination. The decision to administer a vaccine or immunoglobulin was therefore clinical and based on anamnestic criteria. The TQS test was then given to patients who were unaware of their immunity status. Patients who thought they knew it but were not sure were given the TQS test to determine whether the anamnestic collection was supported by the test. The TQS test results were compared with the anamnestic data.Results: Most patients, geriatric and not geriatric, did not know their immune status. Among those who reported knowing their immune status, there was no agreement between the vaccine coverage declared by patients and the TQS test results (p < 0.001), mainly in geriatric patients but also in the control group. Elderly and women had significantly lower positive TQS test results (p < 0.001). There was a statistically significant discrepancy (p < 0.001) between the therapy based on anamnestic data and the TQS test results.Conclusion: The reliability of anamnestic data for the management of patients with tetanus-risk wounds is low and decreases with age, becoming minimal in geriatric patients. Elderly and women are less likely to have an effective vaccination status against tetanus.

Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

“…An Italian research group has demonstrated that, in the years of activity of an OBI (osservazione breve intensiva, unit of short and intensive observation) Team, which had the function of flow coordination, stabilization of complex patients, boarding management, and bed management, a stabilization of boarding and exit block phenomena were observed, despite the increasing number of ED visits and the need for hospitalization of the patients themselves. A containment of LOS times and an improvement in the outcome of some categories of patients was observed as well [81][82][83][84][85][86][87][88]. These findings were in line with data from several other European and American research groups [89][90][91][92][93][94].…”

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

“…Because of these changes, treatment and observation paths have been designed for pathologies that are also very complex or with complex management, such as, for example, severe trauma, heart failure and head trauma. [89][90][91][92][93][94][95]. Although increased crowding negatively affects patient outcomes and satisfaction, the consequences for triage-particularly on wait times and UT and OT frequency-have not yet been extensively investigated.…”

The threat of a new tetanus outbreak due to urban flooding disaster requires vigilance: a narrative review

“…Savioli et al . 54 reported that many individuals are not aware of their vaccination history; this is especially the case among the elderly who are reported to be less aware of their vaccination history. Thus, the elderly is a target group for whom TQS could be useful in identifying tetanus morbidity risk according to their study.…”

“…Considering the effective use of resources during times of disaster, the risk identification shown in Table 4 may be challenging to apply, because vaccination history may be difficult to ascertain during a disaster, and the risk of tetanus with unspecified trauma might be present. Savioli et al 54 reported that many individuals are not aware of their vaccination history; this is especially the case among the elderly who are reported to be less aware of their vaccination history. Thus, the elderly is a target group for whom TQS could be useful in identifying tetanus morbidity risk according to their study.…”