Ablett classified the severity of tetanus into 4 grades based on the clinical findings.
Parameters:
(1) trismus
(2) spasticity
(3) respiratory compromise
(4) muscle spasms
(5) dysphagia
(6) autonomic disturbances including changes in heart rate and blood pressure
Parameters |
Grade I (mild) |
Grade II (moderate) |
trismus |
mild to moderate |
moderate |
spasticity |
general |
rigidity |
respiratory compromise |
none |
mild moderate with respiratory rate 31-40 breaths per minute |
muscle spasms |
none |
mild to moderate but of short duration |
dysphagia |
none or minimal |
mild to moderate |
autonomic disturbances |
none |
none |
Parameters |
Grade III (severe) |
Grade IV (very severe) |
trismus |
severe |
severe to very severe |
spasticity |
generalized |
generalized |
respiratory compromise |
respiratory rate > 40 breaths per minute, apneic spells |
respiratory rate > 40 breaths per minute, apneic spells |
muscle spasms |
reflex prolonged |
reflex prolonged |
dysphagia |
severe |
severe |
autonomic disturbances |
tachycardia > 120 beats per minute |
marked |
where:
• A subclinical (asymptomatic) infection could be graded as Grade 0.
• Marked autonomic disturbances in Grade IV may include severe hypertension and tachycardia alternating with hypotension and bradycardia.
Specialty: Infectious Diseases, Surgery, general, Surgery, orthopedic, Emergency Medicine