Snakebite case management: a cohort study in Northwest Ethiopia, 2012-2020

Abstract

Introduction: Timely and appropriate management of snakebites in the tropics is a lifesaver. Many snakebite patients are being bitten in remote rural areas and do not manage to get in due time to healthcare facilities. This study assessed the clinical features and the risk factors associated with treatment outcomes of snakebite patients admitted at two hospitals in the Northwest of Ethiopia.
 Methodology: In a retrospective cohort study, routinely collected data from 250 patients’ medical charts at University of Gondar Hospital and Metema Hospital, between September 2012 and August 2020, were reviewed.
 Results: The median age of the snakebite cases was 24 years (95% CI = 22-26), with 80.8% male patients. At admission 148/250 patients presented in Clinical stage 1 or 2 (local symptoms only) and 73.7% presented more than 12 hours after the bite, 80.2% received antibiotics and 79.0% antivenom. The median duration of hospitalization was 3 days (95% CI = 3-4); 72% of the patients recovered and were discharged, 10.8% died and 0.5% underwent an amputation. On logistic regression analysis, residence in rural areas (AOR = 2.52, 95 % CI = 1.2-5.3), sign of bacterial superinfection on the bite site (AOR = 4.69. 95% CI = 1.4-15.4), clinical stage 3 or 4 with systemic symptoms or toxic signs at admission (AOR = 4.84, 95% CI = 1.3-18.0) and no treatment with antivenoms (AOR = 6.65, 95% CI = 1.6-27.7) were associated with bad outcome (death, amputation and/or referred/ went against medical advice).
 Conclusions: Timely presentation at early clinical stage, appropriate clinical management and availability of antivenoms are cornerstones to reduce snakebite morbidity and mortality.

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

“…11 The median age of the patients was similar to that found in Australia (33 years) 12 and another study from Colombia (31.7 years) 4 but lower than that reported in other countries (41.0-52.0 years), [13][14][15][16] with a predominance of men, as identified in the different studies (59.3-80.8%). 4,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] In this cohort of patients, the genus of the snake that was most identified was Bothrops, which is consistent with the epidemiological surveillance data of the country. 4,5 A third of all patients could not identify the genus of the snake, a difficulty that also occurs in other countries but in higher proportions (49.0-54.7%).…”

“…26 The wounds occurred mainly in the lower limbs, and the patients reported predominantly pain and edema in the bite area, which is consistent with what has been reported in the literature. 4,[12][13][14]18,21,22,25,27 The use of traditional practices and tourniquets were common behaviors in the out-of-hospital management of some patients, which is consistent with what has been described in other communities. 5,7,9,22,23,25 However, these approaches have not proven effective and can lead to complications.…”

“…5,7,9,22,23,25 However, these approaches have not proven effective and can lead to complications. 2 The ophidian accident was classified in most cases in the mild or moderate category, which is in line with that reported in other international studies (73.6–97.2%) 7,13,14,19,20,22 and national studies (79.9–93.7%). 4,5,9 The proportion of patients classified as having severe ophidian accidents was low (2.6%), similar to that found in Panama and South Korea (0.8% and 2.8%, respectively), 18,19 but contrasts with other publications in which the prevalence was much higher (10.6–26.2%).…”

“…13,14 However, in this report and in other studies, the use of antibiotics predominated widely (63.5% versus 80.2–94.6%). 18,20,22,25,27 Therefore, the prescription of antimicrobials was not only for the treatment of secondary infections but also for preventive management (prophylaxis). With this indication, antibiotics were used to treat half of the patients, consistent with other reports (44.2–75.0%).…”

“…9,13,14,20,21 Snake antivenom was used in the majority of patients, which is consistent with national epidemiological surveillance reports 4,5 and international reports. 13,14,17,18,21,22,25 In pain management, the use of analgesics such as acetaminophen or opioids is recommended. 2 However, approximately one-third of patients received NSAIDs, which should be avoided because of the increased risk of bleeding.…”