Evidence map›Paper›PMID 40721266›Full record

SynthesisBMJ open2025

Mortality and risk factors in hospitalised adult patients with tetanus: a systematic review and meta-analysis.

Zhenlin Chen, Zhijie Lin, Wenbin Zhang, Hantian Hong, Junbin Huang, Zhishi Cai

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. The Future of Vaccines.Vaccines · 2026
    Article
  2. Chinese expert consensus on tetanus prophylaxis in major trauma (2026 Edition).Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2026
    Article
  3. Observational
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Zhenlin ChenDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Zhijie LinDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Wenbin ZhangDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Hantian HongDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Junbin HuangDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Zhishi CaiDepartment of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China caizs243@163.com.ORCID http://orcid.org/0009-0008-2825-9993

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveTetanus is associated with very high mortality, but there is currently no consensus on the mortality and risk factors for hospitalised adult patients with tetanus. Therefore, we conducted this systematic review and meta-analysis to explore the mortality and associated risk factors in hospitalised adult patients with tetanus.

designSystematic review and meta-analysis. DATA SOURCES: PubMed, Web of Science, The Cochrane Library and Embase, covering the period from 1 January 2000 to 5 February 2024. ELIGIBILITY CRITERIA: Observational studies with a focus on the mortality and associated risk factors in hospitalised adult patients with tetanus. DATA EXTRACTION AND SYNTHESIS: Two researchers independently reviewed the studies and extracted the data. The pooled effect sizes for mortality and the total number of hospitalised patients with tetanus were calculated, along with the overall pooled mortality and corresponding 95% CI. Risk factors for mortality were determined using relative risk (RR) and 95% CI. The I

resultsA total of 22 studies were included, comprising 1618 hospitalised adult patients with tetanus. The overall mortality among hospitalised adult patients with tetanus was 32.0% (95% CI: 27.1% to 37.0%). Six risk factors associated with mortality in these patients were identified, including age ≥40 years (RR=1.89, 95% CI: 1.37 to 2.61), incubation period <7 days (RR=2.10, 95% CI: 1.47 to 3.00), onset period <2 days (RR=2.06, 95% CI: 1.30 to 3.29), Ablett classification ≥III (RR=3.40, 95% CI: 1.91 to 6.05), presence of autonomic dysfunction (RR=4.84, 95% CI: 2.36 to 9.94) and the need for mechanical ventilation (RR=2.46, 95% CI: 1.48 to 4.09).

conclusionThe study findings have important implications for clinical practice and public health policy. The high mortality underscored the urgent need to strengthen tetanus prevention strategies, particularly by increasing vaccination coverage and enhancing wound care education in adults aged ≥40 years. The six identified mortality risk factors provided a framework for early risk stratification and targeted interventions in hospitalised patients with tetanus. Meanwhile, more well-designed, large-scale studies are needed for further validation and exploration. PROSPERO REGISTRATION NUMBER: CRD42024533554.

Indexed as

HospitalizationTetanusAdultHospital MortalityHumansObservational Studies as TopicRisk FactorsMeta-AnalysisMortalityRisk FactorsSystematic Review

Identifiers

PMID40721266
PMCPMC12306247

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.