Review of tetanus points of entry. Study of 229 cases

: A revision of tetanus points of entry in 229 tetanic patients who were cared for at the Hospital del Mar, Barcelona, between 1970 and 1983, i carried out in order to determine in which kind of patients a adequate prophylaxis is not performed. It is found that 83% of point of entry are wounds which are not medically assisted. At the same time points of entry are classified in four main groups: a first group consisting of wounds localized in head and extremities (46.8%), second group to contaminated intramuscular injections (21.8%) a third group related to surgical and obstetric procedures (15.3%) an a fourth group which includes other points of entry not included in the previous groups (16.2%). This classification permits the detection of epidemiological characteristics of each group and the observation of the possible influence of point of entry on the evolution and prognosis of tetanus highlighting that the most severe situations are due to intramuscular injections and surgical and obstetric procedures. With this study we can conclude that an adequate antitetanic prophylaxis must not be restricted to high risk patients, but should be extended to the whole population.