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Table 1 Ablett classification of tetanus severity [7]

From: Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

Grade Clinical manifestation
I (mild) Mild to moderate trismus
Generalized spasticity
No respiratory compromise
No spasms
Little or no dysphagia
II (moderate) Moderate trismus
Marked rigidity
Mild to moderate but short spasms
Moderate respiratory compromise with an increased respiratory rate (> 30 breaths per min)
Mild dysphagia
III (severe) Severe trismus
Generalized spasticity
Reflex prolonged spasms
Increased respiratory rate (> 40 breaths per min) apneic spells
Severe dysphagia
Tachycardia (> 120 beats per min)
IV (very severe) Clinical features of grade 3 tetanus
Violent autonomic disturbances involving the cardiovascular system
Severe hypertension and tachycardia alternating with relative hypotension and bradycardia (either of which might be persistent)