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June 16, 1962

The Unreliability of Tetanus Antitoxin Skin Tests After Injury

JAMA. 1962;180(11):972-973. doi:10.1001/jama.1962.03050240068018a

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FOR THOSE persons not immunized against tetanus, the usual practice after injury—particularly in those instances when a history pertinent to allergic sensitivity cannot be effectively elicited from patients—is to give a skin test, observe for 20 to 30 minutes, and then give tetanus antitoxin (TAT) as part of the initial treatment. The manifestations of the skin test to tetanus antitoxin depend upon an adequate cutaneous circulation. Without sufficient blood flow no fluid can escape to produce a wheal; despite local vasodilatation no blood is present to cause a flare. The purposes of this study are to show that a normal cutaneous circulation may be absent for prolonged periods after severe trauma, and to indicate that it would be safer to give tetanus antitoxin after resuscitation rather than in the acute phase following severe injuries.

Following severe trauma 40 patients were skin tested both with diluted tetanus antitoxin and with histamine.

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