Determinants of snakebite mortality in Asia: A systematic review

Ibadullah, Wan Abdul Hannan Wan; Azmi, Muhammad Fikri; Abas, Mohd Ihsanuddin; Rahim, Syed Sharizman Syed Abdul; Jeffree, Mohammad Saffree; Azhar, Zahir Izuan; Hayati, Firdaus; Hassan, Mohd Rohaizat

doi:10.1016/j.amsu.2020.12.040

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…During 2002–2014, the case-fatality rate of SBE in Taiwan was 0.11%, which was lower than that in Taiwan in the early 20 th century (3%–7%) [ 34 , 37 , 48 – 50 ] or in other countries (0.2%–58%) [ 5 , 9 – 11 , 17 , 72 – 79 ]. In this study, patients envenomed by N .…”

Section: Discussionmentioning

confidence: 98%

“…mucrosquamatus , as in previous studies [ 34 , 37 , 48 – 50 ]. In general, the high number of deaths from SBE was due to delayed or inappropriate antivenom treatment [ 9 , 10 , 17 , 72 , 74 ], and more than half of the deaths were from shock due to bleeding, capillary leak syndrome, or myocardial depression [ 10 , 73 , 74 ]. In Taiwan, most of the damage caused by SBE was not fatal due to the availability of antivenom and modern medicine; nor did anyone die from complications that could be aggressively managed, such as anaphylactic shock and necrotizing fasciitis.…”

Section: Discussionmentioning

confidence: 99%

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Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002–2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

et al. 2023

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Introduction In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. Methods and results This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18–64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. Conclusions Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002–2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

et al. 2023

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“…It has been reported that the inability of primary care physicians to recognize systemic signs of envenomation is an important cause of mortality in snakebites. [ 14 ] Although such dramatic neuromuscular paralysis has been reported previously, it is an altogether infrequent presentation and maybe frequently misdiagnosed as brain death by treating primary care physicians and neurologists, as they are unaware of this entity. This may lead to premature withdrawal of supportive care and disastrous outcomes.…”

Section: Discussionmentioning

confidence: 99%

Dramatic neuromuscular paralysis following occult snakebites

Mehta

Kumar

Prabhakar

et al. 2022

Journal of Family Medicine and Primary Care

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Neurotoxic snakebites are a common emergency in tropical countries and account for significant morbidity and mortality worldwide. Manifestations vary from mild ptosis and ophthalmoplegia to severe flaccid paralysis with ventilatory failure. At times, the neuromuscular paralysis may be severe enough for patients to be misdiagnosed as a locked-in syndrome or brain dead. Occult snakebites, wherein patients are unaware of the bite and fang marks are absent, have been reported in kraits, an endemic neurotoxic snake belonging to the Elapidae family. We report a series of three cases in which young males presented with dramatic neuromuscular paralysis and were likely suffering from elapid snake bites. Each of these patients presented an intriguing clinical challenge and had different in-hospital outcomes. Primary care physicians in the emergency department are usually the first respondents to such patients. Owing to a lack of snake bite history and unavailability of specific diagnostic tests, severe envenomation presents a challenge for physicians, unless they are aware of it and a high level of suspicion is maintained.

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“…In some cases, patients may spend hours or even days before reaching a medical facility equipped to treat SBE. Such delays, especially in those patients with severe SBE, have been shown to increase the risk of a poor outcome [ 12 , 14 , 15 , 29 , 30 , 31 , 32 ].…”

Section: Delays To Treatmentmentioning

confidence: 99%

“…While under 6 h is loosely described as the treatment time target [ 15 , 31 , 36 ], this has not been clearly defined, with studies reporting different time frames. Jayaram et al [ 16 ] report a “bite to needle” time of more than 6 h as having worse outcomes, such as longer hospital stays, more antivenom required, and higher complication rates.…”

Section: Delays To Treatmentmentioning

confidence: 99%

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

Wood

2023

Toxins

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Snakebite-related fatalities disproportionately affect populations in impoverished socio-economic regions, marked by limited access to adequate healthcare and constrained antivenom availability. Early medical intervention is pivotal in mitigating mortality and morbidity associated with snakebite envenoming (SBE). While clinical assessment remains fundamental in treating SBE, this review aims to spotlight objective parameters that could also affect outcomes. Selected studies that identify factors associated with poor outcomes are predominantly region-specific, single-site, and observational, yet collectively reveal similar findings. They consistently report factors such as treatment delays, susceptibility in vulnerable groups such as children and pregnant women, as well as various biochemical and haematological abnormalities. Acute kidney injury (AKI), low platelets, leucocytosis, abnormal coagulation, and elevated creatine kinase (CK) all show an association with poor outcomes. Furthermore, recognising rare and unusual SBE presentations such as adrenal insufficiency, severe hypertension, intracranial haemorrhage, acute angle closure glaucoma, and bowel ischaemia also has a bearing on outcomes. Despite the integration of these parameters into clinical decision tools and guidelines, the validation of this evidence is limited. This review underscores the imperative for high-quality, multi-centre studies aligned with consensus-driven Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) to validate and strengthen the current evidence.

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Determinants of snakebite mortality in Asia: A systematic review

Cited by 7 publications

References 17 publications

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002–2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002–2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

Dramatic neuromuscular paralysis following occult snakebites

Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review

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