Physician compliance with tetanus guidelines for admitted versus discharged patients

The Advisory Committee of Immunization Practice (ACIP)¹ has established guidelines for tetanus immunoprophylaxis for patients who present to the emergency department (ED) with wounds. We assessed physician compliance with these guidelines for admitted versus discharged patients. The data in this study comes from one institution involved in a recently published prospective observational study that was conducted at 5 university-affiliated hospitals.² Of 400 patients enrolled, 65/397 (16.3%) did not receive tetanus immunoprophylaxis in accordance with ACIP guidelines. Emergency physicians were less likely to adhere to the ACIP tetanus guidelines when admitting patients to the hospital. Of patients discharged, (89%), 292 of 325 were treated in accordance with ACIP guidelines compared with 39/71 (55%) of admitted patients (P < 0.001). Admitted patients were also more likely to sustain tetanus-prone wounds. Despite a propensity to present with tetanus-prone wounds, patients admitted to the hospital were less likely to receive tetanus immunoprophylaxis in accordance with ACIP guidelines.