破傷風類毒素及免疫球蛋白於急診之使用.pptVIP

Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds David A. Talan, MD Fredrick M. Abrahamian, DO Gregory J. Moran, MD William R. Mower, MD, PhD Kumar Alagappan, MD Brian R. Tiffany, MD, PhD Charles V. Pollack Jr., MA, MD Mark T. Steele, MD Lala M. Dunbar, MD, PhD Mary D. Bajani, PhD Robbin S. Weyant, PhD Steven M. Ostroff, MD * March 2004 ? Volume 43 ? Number 3 Reporter:Chen Chien-Yun Introduction Tetanus continues to occur in the United States despite the widespread availability of a safe and effective vaccine. Clinical tetanus in the United States has predominantly been limited to the elderly who were born before childhood immunization became routine. Previous seroprevalence studies have found high rates of underprotection among the elderly and immigrants. No seroprevalence data exist among emergency department (ED) patients seeking wound care. Recently, the epidemiology of tetanus has shifted to younger populations that include parenteral drug users. Tetanus can be potentially prevented by episodic administration of tetanus toxoid either alone or with tetanus immunoglobulin, as dictated by recommendations of the Advisory Committee on Immunization Practices. To evaluate the effectiveness of current tetanus prophylaxis recommendations. To establish an understanding of the degree of tetanus risk among ED patients presenting with wounds and the extent to which episodic tetanus prophylaxis is appropriately administered. Methods This was a prospective observational case series conducted at 5 urban university-affiliated EDs in collaboration with the US Centers. Patients selected were a convenience sample aged 18 years or older and presenting for wound-related complaints between March 1999 and August 2000. All patients had serum collected for measurement of baseline tetanus antitoxin level. All patients were asked to return for follow-up care at days 5 t