Classifying snakebite in South Africa: Validating a scoring system

Abstract

Objective. To develop and validate a scoring system for managing snakebites in South Africa (SA). Methods. We studied all snakebite admissions to a regional hospital in KwaZulu-Natal, SA. The primary outcome was an active treatment intervention (ATI) defined as antivenom treatment or any surgical procedure. The development cohort consisted of 879 patients with snakebite who presented to the Ngwelezane Hospital Emergency Department from December 2008 to December 2013. Factors predictive of ATI and the optimal cut-off score for predicting an ATI were identified. These factors were then used to develop a standard scoring system. The score was then tested prospectively for accuracy in a new validation cohort consisting of 100 patients admitted for snakebite to our unit from 1 December 2014 to 31 March 2015. Accuracy of the score was determined. Results. Of 879 snakebite admissions, 146 in the development cohort and 40 of 100 in the development validation cohort reached the primary endpoint of an ATI. Six risk predictors for ATI were identified from the development cohort: age <14 years (odds ratio (OR) 2.13), delay to admission >7 hours (OR 4.63), white cell count >10 × 10 9 /L (OR 3.15), platelets <92 × 10 9

Surgical Considerations for Pediatric Snake Bites in Low‐ and Middle‐Income Countries

“…Since management of snake bite is dependent on the type of envenomation and identification of the type of snake is seldom possible, the clinical management strategy is based on a syndromic approach [21]. Few data exist, however, to guide surgical management including fasciotomy [7, 11, 15, 25]. In this study, the majority of patients displayed a syndrome of PPS with few patients demonstrating PW or B syndromes.…”

“…Poor infrastructure, long transfer times, and lack of access to appropriate anti-venom allow snake bites to remain an ongoing source of both morbidity and mortality in sub-Saharan Africa [13,14]. In light of this, it is important to evaluate and optimize the surgical management of this injury [15]. This study evaluated snake bite injuries in children and adolescents in the western third of the Kwa-Zulu-Natal province in South Africa with the purpose of identifying factors associated with the need for surgical intervention such as fasciotomy.…”

A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study

“…Apart from the SSS, studies from Korea have used the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation to classify viper bite patients with VICC though prognostic implications were unclear [50,51]. Another prognostic score is the Zululand Severity Score developed in South Africa for determining whether the patient requires antivenom or surgical intervention [52]. A species-specific severity grading for Indian snakes was evolved by Kumar V et al and was reported in subsequent hospital based studies [53,54].…”