Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000–2014). Part 2: Prognostic assessment

G. van Galen, C.M. Westermann

    Research output: Contribution to journalArticleAcademicpeer-review


    Objective – To identify prognostic variables for adult equids and foals with tetanus.
    Design – Multicenter retrospective study (2000–2014).
    Setting – Twenty Western, Northern, and Central European university teaching hospitals and private referral
    Animals – One hundred fifty-five adult equids and 21 foals with tetanus.
    Interventions – None.
    Measurements andMain Results – Variables from history and clinical examination were statistically compared
    between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors).
    Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and
    66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds
    and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base
    excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade.
    Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration
    on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and
    seizures during hospitalization, treatmentwith glycerol guaiacolate, intravenous fluids, and intravenous glucose
    solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft
    food and drinking, older age, and longer hospitalization delay. Outcome was not different between different
    tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT
    dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved
    outcome and shorter hospitalization.
    Conclusions – Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals
    and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based
    information related to patient management. Several prognostic indicators relate to the ability to eat or drink,
    and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant
    effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT
    dosages. Further evaluation is warranted.
    Original languageEnglish
    Pages (from-to)697–706
    Number of pages10
    JournalJournal of Veterinary Emergency and Critical Care
    Issue number6
    Publication statusPublished - Nov 2017


    • Clostridium tetani
    • epidemiology
    • horses
    • infectious disease
    • survival


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