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This study was performed to elucidate the current clinical features and outcomes of tetanus using a national inpatient database in Japan.We used the Japanese Diagnosis Procedure Combination inpatient database to retrospectively investigate patients with tetanus from July 2010 to March 2016. We examined the patients' characteristics; the proportions of patients requiring tracheal intubation, mechanical ventilation, and tracheostomy; and the discharge status.We identified 499 patients who were diagnosed with tetanus. No patient had a diagnosis of tetanus neonatorum or obstetric tetanus. The median age was 74 years. Overall, 53.5% of the patients required intubation and mechanical ventilation. Among patients who required intubation and mechanical ventilation, 80.6% started it within 3 days of admission, and 77.5% required tracheostomy during hospitalization. The median duration of mechanical ventilation was 23 days. The median length of hospitalization was 35 days. The proportions of patients who were discharged to home and to locations other than home were 58.1% and 35.1%, respectively. The in-hospital mortality was 6.8%.The present study suggests that acute-care physicians should be ready to provide intensive care for patients with tetanus and cooperate with medical social workers and families for subsequent long-term nursing care.Approximately half of patients with tetanus needed mechanical ventilation.Three-quarters of patients with mechanical ventilation required tracheostomy.In-hospital mortality of tetanus patients in Japan was 6.8%.