A prospective analysis of adherence to standard treatment guidelines in management of snakebite in a tertiary care teaching hospital of rural Bengal, India

Abstract

Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future.

A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

“…The percentage decreased in prospective year to 70 % reinforcing the fact that more initiatives are needed in increasing the awareness regarding snakebite in rural population. 4,6,11,13 Snakebites in the early morning and foot being the commonest site of bite followed by legs and upper limbs was seen in both years as has been recorded in other studies. 4,11 Polyvalent ASV remained the mainstay of snakebite victims in our country knowing the fact that it is only able to neutralise the free unbound toxins.…”

“…4,6,11,13 Snakebites in the early morning and foot being the commonest site of bite followed by legs and upper limbs was seen in both years as has been recorded in other studies. 4,11 Polyvalent ASV remained the mainstay of snakebite victims in our country knowing the fact that it is only able to neutralise the free unbound toxins. It remains ineffective to the bound portion, so timely institution of ASV is recommended as there are studies proving to have direct correlation with patients outcome.…”

“…8,9 The percentage for venomous snakebite slightly decreased in prospective year to almost 60% like another study conducted in same institution due to the implementation of national STG the treatment initiation with ASV greatly depended on a judicious screening of snakebite patients considering clinical features and observation rather than infusing ASV to everyone. 10,11 Introduction of National STG was aimed in attenuating the scarcity of ASV by its judicious application which was fulfilled by giving training to the physicians in this institution. With such approach it was evident that the imprudent use of ASV was minimised.…”

“…Though the ratio of neurotoxic to hematotoxic envenomation varied between two groups but neurotoxic had a larger proportion depicting a similar likeness to other studies. 4,8,11 There was a gross deficit in awareness regarding early presentation of snakebite victim the outcome of which was a delayed presentation of snakebite victim to nearest health facility. Quack and indigenous treatments often take up a good number of hours before a patient presents to the health care facility.…”

“…13 A systemic review of randomized trials comparing high and low dose of ASV concluded that low dose have the similar efficacy and cost effective in treatment of snakebite poisoning but National STG proposes to start with 10 vials as infusion over 30 minutes for neurotoxic envenomation followed by a repeat 10 vial dose of ASV if no improvement is seen. 7,11,14 Low dose infusion therapy and high dose intermittent bolus therapy, both are followed in case of vasculotoxic snakebite. Repeat dose by 6 vials 6 hourly as bolus therapy is given till clotting time normalizes.…”