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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


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)