A 10-year retrospective analysis of snakebite cases in the mediterranean region

Objective: The aim of our study is to contribute valuable data to the literature on the severity of poisoning caused by snake species in our region, including the effectiveness and dosage of antivenom used, factors affecting the length of hospital stay, and the rate of development of permanent sequelae. Materials and Methods: Our study was conducted on patients who presented to the Adult Emergency Department of Çukurova University between January 1, 2014, and December 31, 2023 (10 years), due to snakebites. The patients' demographic data (age, gender), medical history, type of presentation, vital signs, stage of poisoning, results of blood tests, treatments given, method and duration of antivenom administration, complications, length of stay, outcomes, and sequelae status were evaluated. Results: In our study, 67.1 % of the patients were male and the mean age of 49.8±16.7 years. It was found that 26.8 % of the patients were in Stage 0, 33.9 % in Stage 1, 28.9% in Stage 2, and 10.4 % in Stage 3. Antivenom was administered to 68.1 % of the patients, with an average total dose of 3.4 ± 1.8 vials. The duration of antivenom administration was 30-60 minutes in all patients. An antivenom-related allergy developed in 8.4 % of the patients. Patients who developed an allergic reaction had a longer hospital stay and a higher frequency of TDP (Therapeutic Drug Plan) administration (p<0.05). The average hospital stay was 2.0 ± 1.5 days. It was found that patients transferred from external centers had a statistically significant higher stage at presentation, received higher doses of antivenom, and had a longer hospital stay. When evaluating the site of the bite, bites on the upper extremities and fingers were found to have a higher stage (p<0.05). A positive correlation was found between the length of hospital stay and WBC, PTZ, INR, glucose, BUN, and D-dimer values, and a negative correlation with platelet value. Regarding the permanent sequelae status, 3 patients had minimal joint movement limitations, 1 patient had a finger amputation, and 1 patient had a permanent neurological sequela. Conclusion: Snakebites remain a significant health issue in rural areas of our country. Access to antivenom treatment is life-saving. The longer hospital stays and higher stages of patients transferred from other centers highlight the importance of early antivenom treatment. Due to the higher stages of bites on the upper extremities and fingers, these areas require more serious monitoring, especially in terms of compartment syndrome. It can be stated that the use of an average of 4 vials of antivenom, with an administration duration of 30-60 minutes, provided effective recovery in most patients, with no mortality and very low rates of sequelae. In our region, it can be said that early effective treatment and dynamic monitoring processes result in the recovery of nearly all patients, with low incidence of life-threatening antivenom allergies, and that plasmapheresis is a treatment alternative in very rare complicated cases. Keywords: Snakebites, emergency department, antivenom.