Classification of Ablett for the Clinical Severity of Tetanus

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.

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