Philip Buttaravoli, and Stephen M. Leffler：Laceration, Simple．Minor Emergencies , Third Edition， Chapter 143 , 553-566, Saunders, 2012.
Jennifer L Liang, Tejpratap Tiwari, Pedro Moro, Nancy E Messonnier, Arthur Reingold, Mark Sawyer, Thomas A Clark
Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Recomm Rep. 2018 Apr 27;67(2):1-44. doi: 10.15585/mmwr.rr6702a1. Epub 2018 Apr 27.
Abstract/Text
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks' gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.
日本外傷学会編：外傷初期診療ガイドライン JATEC 改訂第6版 p.285 図A1-1 へるす出版、2021年.
National Center for Immunization and Respiratory Diseases
General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Recomm Rep. 2011 Jan 28;60(2):1-64.
Abstract/Text
This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previous ACIP recommendations on the following topics: adult vaccination (CDC. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates-assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219-20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years-linkage of vaccination and WIC services. MMWR 1996;45:217-8); adolescent immunization (CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combination vaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]). Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination, as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2) reordering of the report content, with vaccine risk-benefit screening, managing adverse reactions, reporting of adverse events, and the vaccine injury compensation program presented immediately after the discussion of contraindications and precautions; 3) stricter criteria for selecting an appropriate storage unit for vaccines; 4) additional guidance for maintaining the cold chain in the event of unavoidable temperature deviations; and 5) updated revisions for vaccination of patients who have received a hematopoietic cell transplant. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive details. This report, ACIP recommendations for each vaccine, and additional information about vaccinations are available from CDC at http://www.cdc.gov/vaccines.
William L Atkinson, Larry K Pickering, Benjamin Schwartz, Bruce G Weniger, John K Iskander, John C Watson, Centers for Disease Control and Prevention
General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).
MMWR Recomm Rep. 2002 Feb 8;51(RR-2):1-35.
Abstract/Text
This report is a revision of General Recommendations on Immunization and updates the 1994 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1994;43[No. RR-1]:1-38). The principal changes include expansion of the discussion of vaccination spacing and timing, recommendations for vaccinations administered by an incorrect route, information regarding needle-free injection technology, vaccination of children adopted from countries outside the United States, timing of live-virus vaccination and tuberculosis screening, expansion of the discussion and tables of contraindications and precautions regarding vaccinations, and addition of a directory of immunization resources. These recommendations are not comprehensive for each vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for additional details. This report, ACIP recommendations for each vaccine, and other information regarding immunization can be accessed at CDCs National Immunization Program website at http.//www.cdc.gov/nip (accessed October 11, 2001).
Philip Buttaravoli, and Stephen M. Leffler：Puncture Wounds．Minor Emergencies , Third Edition， Chapter 151 , 599-603, Saunders, 2012.
K Farion, M H Osmond, L Hartling, K Russell, T Klassen, E Crumley, N Wiebe
Tissue adhesives for traumatic lacerations in children and adults.
Cochrane Database Syst Rev. 2002;(3):CD003326. doi: 10.1002/14651858.CD003326.
Abstract/Text
BACKGROUND: Tissue adhesives have been used for many years to close simple lacerations as an alternative to standard wound closure (sutures, staples, adhesive strips). They offer many potential advantages over standard wound closure, including ease of use, decrease in pain and time to apply, as well as not requiring a follow-up visit for removal. Many studies have compared tissue adhesives and standard wound closure to determine the cosmetic outcome as well as these other secondary outcomes in their respective study populations. However, due to the wide variation in study parameters, there are no generalisable, definitive answers about the effectiveness of tissue adhesives. No study has been adequately powered to assess differences in complications, which are rare.
OBJECTIVES: To summarize the best available evidence for the effect of tissue adhesives in the management of traumatic lacerations in children and adults.
SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (CD ROM 2001 Issue 4), the Cochrane Wounds Group Specialized Trials Register (Nov 2001), MEDLINE (1966 to Oct 1, 2001), and EMBASE (1988 to Sept 1, 2001) for relevant randomised controlled trials (RCTs). We also searched the citations of selected studies, and we contacted relevant authors and manufacturers of tissue adhesives to inquire about other published and unpublished trials.
SELECTION CRITERIA: We included RCTs comparing tissue adhesives versus standard wound closure or tissue adhesive versus tissue adhesive for acute, linear, low tension, traumatic lacerations in an emergency or primary care setting. Trials evaluating tissue adhesives for surgical incisions or other types of wounds were not considered.
DATA COLLECTION AND ANALYSIS: Data from eligible studies were extracted by one reviewer and checked for accuracy by a second reviewer. Two reviewers independently assessed masked copies for quality. Outcomes of cosmesis (subgroups of age, wound location and need for deep sutures), pain, procedure time, ease of use and complications were analysed separately for two comparisons: 1) tissue adhesive versus standard wound care; and 2) tissue adhesive versus tissue adhesive.
MAIN RESULTS: Eight studies compared a tissue adhesive with standard wound care. No significant difference was found for cosmesis at any of the time points examined, using either Cosmetic Visual Analogue Scale (CVAS) or Wound Evaluation Score (WES). Data were only available for subgroup analysis for age; no significant differences were found. Pain scores (Parent VAS WMD -15.7 mm; 95% CI -21.9, -9.5) and procedure time (WMD -5.6 minutes; 95% CI -8.2, -3.1) significantly favoured tissue adhesives. No studies reported on ease of use. Small but statistically significant risk differences were found for dehiscence (favouring standard wound care NNH 25 95% CI 14, 100) and erythema (favouring tissue adhesive NNH 8 95% CI 4, 100). Other complications were not significantly different between treatment groups. Only one study was identified that compared two tissue adhesives (butylcyanoacrylate (Histoacryl TM) versus octylcyanoacrylate (Dermabond TM)) for pediatric facial lacerations. No significant difference was found for cosmesis using CVAS at 1-3 months, or using WES at 5-14 days and 1-3 months. Similarly, no significant difference was found in pain, procedure time or complications. Results for ease of use were incomplete as reported.
REVIEWER'S CONCLUSIONS: Tissue adhesives are an acceptable alternative to standard wound closure for repairing simple traumatic lacerations. There is no significant difference in cosmetic outcome between tissue adhesives and standard wound closure, or between different tissue adhesives. They offer the benefit of decreased procedure time and less pain, compared to standard wound closure. A small but statistically significant increased rate of dehiscence with tissue adhesives must be considered when choosing the closure method (NNH 25).
Sherry Yang, David Ozog
Comparison of Traditional Superficial Cutaneous Sutures Versus Adhesive Strips in Layered Dermatologic Closures on the Back-A Prospective, Randomized, Split-Scar Study.
Dermatol Surg. 2015 Nov;41(11):1257-63. doi: 10.1097/DSS.0000000000000507.
Abstract/Text
BACKGROUND: Bilayered suture repairs have become the standard of care in dermatologic surgery. However, the benefit of superficial sutures for fine epidermal alignment on high-tension areas remains unclear.
OBJECTIVE: To compare the overall cosmetic outcome of traditional epidermal sutures with adhesive strips in layered dermatologic repairs on the back.
METHODS: A total of 10 patients underwent standard elliptical excision on the back followed by subcutaneous closure with 4-0 polyglactin 910 buried sutures. Each half of the wound was then randomized to either 4-0 polypropylene running sutures or 1/4″ Steri-Strip films for epidermal approximation. Postoperative evaluations were completed in person at 2 weeks, 3 months, and 6 months using the Patient and Observer Scar Assessment Scale.
RESULTS: The adhesive strip group had superior appearance and greater patient satisfaction at 2 weeks. Evaluation at 3 months and 6 months revealed no statistically significant difference in overall scar cosmesis.
CONCLUSION: Adhesive strips result in equivalent long-term scar outcome when compared with traditional epidermal sutures and should be viewed as a time-saving alternative in layered dermatologic repairs on the back. This finding further corroborates that undermining and placement of deep buried sutures are the primary determinants of wound appearance.
Douglas D Cooper, Rawle A Seupaul
Is water effective for wound cleansing?
Ann Emerg Med. 2012 Nov;60(5):626-7. doi: 10.1016/j.annemergmed.2012.06.011. Epub 2012 Jul 28.
Abstract/Text
Ronald M Moscati, James Mayrose, Robert F Reardon, David M Janicke, Dietrich V Jehle
A multicenter comparison of tap water versus sterile saline for wound irrigation.
Acad Emerg Med. 2007 May;14(5):404-9. doi: 10.1197/j.aem.2007.01.007.
Abstract/Text
OBJECTIVES: To compare wound infection rates for irrigation with tap water versus sterile saline before closure of wounds in the emergency department.
METHODS: The study was a multicenter, prospective, randomized trial conducted at two Level 1 urban hospitals and a suburban community hospital. Subjects were a convenience sample of adults presenting with acute simple lacerations requiring sutures or staples. Subjects were randomized to irrigation in a sink with tap water or with normal saline using a sterile syringe. Wounds were closed in the standard fashion. Subjects were asked to return to the emergency department for suture removal. Those who did not return were contacted by telephone. Wounds were considered infected if there was early removal of sutures or staples, if there was irrigation and drainage of the wound, or if the subject needed to be placed on antibiotics. Equivalence of the groups was met if there was less than a doubling of the infection rate.
RESULTS: A total of 715 subjects were enrolled in the study. Follow-up data were obtained on 634 (88%) of enrolled subjects. Twelve (4%) of the 300 subjects in the tap water group had wound infections, compared with 11 (3.3%) of the 334 subjects in the saline group. The relative risk was 1.21 (95% confidence interval = 0.5 to 2.7).
CONCLUSIONS: Equivalent rates of wound infection were found using either irrigant. The results of this multicenter trial evaluating tap water as an irrigant agree with those from previous single institution trials.
Ritin Fernandez, Rhonda Griffiths
Water for wound cleansing.
Cochrane Database Syst Rev. 2012 Feb 15;2:CD003861. doi: 10.1002/14651858.CD003861.pub3. Epub 2012 Feb 15.
Abstract/Text
BACKGROUND: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use.
OBJECTIVES: The objective of this review was to assess the effects of water compared with other solutions for wound cleansing.
SEARCH METHODS: For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 9 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 8, 2011); Ovid EMBASE (2010 to 2011 Week 44); and EBSCO CINAHL (2010 to 4 November 2011).
SELECTION CRITERIA: Randomised and quasi randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing.
DATA COLLECTION AND ANALYSIS: Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.
MAIN RESULTS: We included 11 trials in this review. We identified seven trials that compared rates of infection and healing in wounds cleansed with water and normal saline; three trials compared cleansing with no cleansing and one trial compared procaine spirit with water. There were no standard criteria for assessing wound infection across the trials, which limited the ability to pool the data. The major comparisons were water with normal saline, and tap water with no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16, (95% CI 0.01 to 2.96). Tap water was more effective than saline in reducing the infection rate in adults with acute wounds (RR 0.63, 95% CI 0.40 to 0.99). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection when compared to saline (RR 1.07, 95% CI 0.43 to 2.64). We identified no statistically significant differences in infection rates when wounds were cleansed with tap water or not cleansed at all (RR 1.06, 95% CI 0.07 to 16.50). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected.
AUTHORS' CONCLUSIONS: There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However there is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.
FLOW Investigators, Mohit Bhandari, Kyle J Jeray, Brad A Petrisor, P J Devereaux, Diane Heels-Ansdell, Emil H Schemitsch, Jeff Anglen, Gregory J Della Rocca, Clifford Jones, Hans Kreder, Susan Liew, Paula McKay, Steven Papp, Parag Sancheti, Sheila Sprague, Trevor B Stone, Xin Sun, Stephanie L Tanner, Paul Tornetta, Ted Tufescu, Stephen Walter, Gordon H Guyatt
A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.
N Engl J Med. 2015 Dec 31;373(27):2629-41. doi: 10.1056/NEJMoa1508502. Epub 2015 Oct 8.
Abstract/Text
BACKGROUND: The management of open fractures requires wound irrigation and débridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure.
METHODS: In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline). The primary end point was reoperation within 12 months after the index surgery for promotion of wound or bone healing or treatment of a wound infection.
RESULTS: A total of 2551 patients underwent randomization, of whom 2447 were deemed eligible and included in the final analyses. Reoperation occurred in 109 of 826 patients (13.2%) in the high-pressure group, 103 of 809 (12.7%) in the low-pressure group, and 111 of 812 (13.7%) in the very-low-pressure group. Hazard ratios for the three pairwise comparisons were as follows: for low versus high pressure, 0.92 (95% confidence interval [CI], 0.70 to 1.20; P=0.53), for high versus very low pressure, 1.02 (95% CI, 0.78 to 1.33; P=0.89), and for low versus very low pressure, 0.93 (95% CI, 0.71 to 1.23; P=0.62). Reoperation occurred in 182 of 1229 patients (14.8%) in the soap group and in 141 of 1218 (11.6%) in the saline group (hazard ratio, 1.32, 95% CI, 1.06 to 1.66; P=0.01).
CONCLUSIONS: The rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures. The reoperation rate was higher in the soap group than in the saline group. (Funded by the Canadian Institutes of Health Research and others; FLOW ClinicalTrials.gov number, NCT00788398.).
Philip Buttaravoli, and Stephen M. Leffler：Traumatic Tattoos and Abrasions．Minor Emergencies , Third Edition，Chapter 158 , 632-634, Saunders, 2012.
Gregory W Thomas, Leonard T Rael, Raphael Bar-Or, Richard Shimonkevitz, Charles W Mains, Denetta Sue Slone, Michael L Craun, David Bar-Or
Mechanisms of delayed wound healing by commonly used antiseptics.
J Trauma. 2009 Jan;66(1):82-90; discussion 90-1. doi: 10.1097/TA.0b013e31818b146d.
Abstract/Text
BACKGROUND: The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.
METHODS: Cell proliferation assays were performed by culturing fibroblasts in the presence of commonly used antiseptics. Migration was evaluated using scratch assays in which monolayers were "wounded" and cellular movement was monitored by digital photography. Matrix metalloproteinase (MMP) release was analyzed by zymography.
RESULTS: H2O2 and povidone-iodine reduced both migration and proliferation of fibroblasts in a dose-dependent fashion. Treatment with silver-containing antiseptics and chlorhexidine exhibited reductions in proliferation at high concentrations, but enhanced growth at lower doses. Silver-containing compounds and chlorhexidine also proved to be the least detrimental to migration in these assays. metalloproteinase release from the cells was differently affected depending on the dosage and class of antiseptic applied.
CONCLUSIONS: When debridement of the wound bed is not sufficient to reduce bacterial loads, the application of broad-spectrum antiseptics maybe indicated. Our data would suggest that H2O2 and iodine are poor choices, potentially retarding the contribution of fibroblasts to the healing process. Silver sulfadiazine and chlorhexidine, at levels still proven to be bactericidal, had fewer detrimental effects on fibroblast activity in these assays. The silver-containing antiseptics may even increase the proliferative potential of these cells in culture.
Soumyadeep Bhaumik, Richard Kirubakaran, Sirshendu Chaudhuri
Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite.
Cochrane Database Syst Rev. 2019 Dec 6;12:CD011822. doi: 10.1002/14651858.CD011822.pub2. Epub 2019 Dec 6.
Abstract/Text
BACKGROUND: Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review.
OBJECTIVES: To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds.
SEARCH METHODS: In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA: We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS: We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated.
AUTHORS' CONCLUSIONS: All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Peter Rhee, Mary K Nunley, Demetrios Demetriades, George Velmahos, Jay J Doucet
Tetanus and trauma: a review and recommendations.
J Trauma. 2005 May;58(5):1082-8. doi: 10.1097/01.ta.0000162148.03280.02.
Abstract/Text
BACKGROUND: This review covers the pathogenesis and treatment of the disease along with the reexamination of the current recommendations for prophylaxis against tetanus in the United States. Although tetanus is still a major problem worldwide, the incidence in North America has become almost negligible because of the highly effective primary immunization program. Recently, there have been no deaths reported attributable to tetanus in the United States in trauma patients who had received the primary childhood immunization. However, tetanus immunization and prophylaxis in the acute injury setting is frequently misused and misunderstood.
METHODS: A review of the literature regarding tetanus.
RESULTS: After review, the authors recommend tetanus toxoid in adults only if it has been more than 10 years since their last immunization. There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against the next injury and not the current injury. Tetanus-diphtheria toxoid is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States.
CONCLUSION: The review of reported cases of tetanus demonstrates that it is not possible to clinically determine which wounds are tetanus prone, as tetanus can occur after minor, seemingly innocuous injuries, yet is rare after severely contaminated wounds. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.
