Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: An Indian tertiary care hospital-based prospective study

Abstract

Objective: We undertook this study to assess the clinical profile and outcome determinants of different snake envenomation as well as to assign species-specific severity grade to different cases based on clinico - laboratory evidence scale.

Materials and methods: A prospective clinico - epidemiologic evaluation for outcome determinants of snakebite envenomation was carried out based on a clinico - laboratory severity grading scale, among 76 patients over a period of 2 years, in a tertiary care hospital in southern India.

Results: Majority of patients were male agricultural workers (53.9%) followed by housewives (19.7%), and students (9.2%). Occurrence of viper snake envenomation with hemotoxic syndrome (73.68%) was highest followed by cobra and krait envenomation with neurotoxic (19.73%) and hemo - neurotoxic (5.3%) syndrome, respectively. On the contrary, maximum mortality and severity was seen in krait (60%) followed by cobra (13.33%) and viper (8.9%) envenomation. The average dose of anti-snake venom (ASV) administered varied from 9.83 (±7.22) to 20.25 (±4.92) vials throughout grade I to IV in all snake species envenomation. An increase in severity grade, ASV dose, and mortality were observed with the corresponding delay in 'bite to needle time.' Also, initial traditional treatments and krait species envenomation were significantly associated with higher grades of severity and mortality.

Conclusion: There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

Keywords: Antivenins; envenomation; ophitoxaemia; severity grade; snakebite.

Appendix 1

^*Summary of species–specific severity grading of Indian snake envenomation based on clinico–laboratory profile