Tendência temporal do tétano acidental no período de 1981 a 2004 em Pernambuco com avaliação do impacto da assistência em unidade de terapia intensiva sobre a letalidade

Abstract

Apesar da redução na incidência de tétano acidental no Brasil, não houve queda significativa na letalidade. Nesta série de casos, comparamos a letalidade antes e após o estabelecimento padrão de manejo em unidade de terapia intensiva do paciente com tétano no Hospital Universitário Oswaldo Cruz, no período de 1981 a 2004. Em 24 anos, foram internados 1.971 pacientes e antes do manejo em Unidade de terapia intensiva a letalidade era de 35%. Durante 1997 foi instituída a unidade de terapia intensiva para assistência dos pacientes com tétano, e de 1998 a 2004, a letalidade caiu para 12,6%, OR= 0,27 (IC95%= 0,18- 0,39); p<0,001. Esta tendência foi evidenciada em todas as faixas etárias e em ambos os sexos. A centralização da assistência a esses pacientes em um único serviço especializado com Unidade de terapia intensiva de forma precoce, portanto, tem sido decisiva na redução da letalidade, por contar com a vasta experiência da equipe de saúde no manejo do tétano e melhor tratamento sintomático, antecipando as graves complicações da doença.

An Epidemiological Profile of Accidental Tetanus Cases in a Referral Hospital, 2007-2013

“…There is evidence that tetanus reaches a higher proportion of the most productive age group, and can be justified by the greater exposure of this group to traumatic injury, and there is a greater easiness of infection in the work exercise [7]. Also, the elderly population was affected by the disease significantly, reiterating the results found in other studies [2,4,9]. The risk of major involvement in this group is justified by the decrease in immunity, as levels of tetanus protective antibodies decrease with advancing age [12].…”

“…The results of this research point to a predominance of cases in males. Other similar Brazilian studies have shown that this part of the population is the most affected by the disease [1,2,4,7]. This situation has been explained by the fact that men are more numerous in the labor market and, consequently, more exposed to occupational accidents risks, as well as the health strategies directed to this public are still incipient in the country [8].…”

“…The Northeast region has the highest number of cases (36.54%) [3]. In 2004, 15% of the cases reported in this region were from the state of Pernambuco, with an average of 40 cases of accidental tetanus annually in the last six years [4]. Its tendency is a reduction in the number of cases.…”

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…ICU admission is particularly beneficial for elderly patients, whose mortality rates are higher. (1,2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) In the ICU, appropriate monitoring and quick detection of complications can be performed by a trained multidisciplinary team. (12)(13)(14)17,19,20) We highlight five studies that showed reduced mortality after ICU admission in tetanus patients.…”

“…(14) A Brazilian study from Recife-PE showed a drop from a mortality of 35% in 1631 patients treated outside of the ICU between 1981-1996 to 12.6% in 638 patients treated after the ICU was established (p < 0.001). (18) However, several authors have persistently high mortality rates in spite of ICU care. (4,(21)(22)(23) This finding suggests that in addition to the ICU facility itself, trained staff and advanced technology appropriate to such severely ill patients' needs are important.…”