Retrospective study of clinical, laboratory characteristics and treatments of patients admitted due to snake bites

OBJECTIVE: In our study, we aimed to show the effects of demographic characteristics, clinical findings, laboratory values, comorbidities, incorrect prehospital interventions and hospital treatments on snakebite staging, length of hospital stay, and antivenom doses applied in patients admitted to the emergency department due to snakebites. MATERIALS AND METHODS: The study included patients with a history of snake contact who presented to the Adıyaman Training and Research Hospital Emergency Department between January 1, 2021, and May 30, 2024. Demographic and clinical characteristics, laboratory parameters, length of stay, and treatments administered to these patients were examined. RESULTS: The study included 102 patients bitten by snakes. The mean age of the patients was 43.21 ± 17.35 years, and cases were most common in the 4th and 5th decades. The male-to-female ratio in the patient group was 2:1. The upper extremity was the most frequently bitten area. When the seasonal distribution of cases was examined, it was seen that the most frequent presentations occurred in the summer (47.1%). Patients referred from surrounding districts were found to be at higher stages of infection and to have received higher doses of antivenom than those referred from the city center (p<0.05 for each) According to the stage at presentation to the emergency department, 18 (17.6%) patients were assessed as stage 0, 63 (61.8%) as stage 1, 18 (17.6%) as stage 2, and 3 (2.9%) as stage 3. The most common examination finding was edema (n=74, 72.5%), while the most common complaint was pain at the bite site (n=75, 73.5%). Antivenom treatment was initiated in 52% of the patients in the emergency department, and additional antivenom was administered in the hospital to 20% of the admitted patients. Total antivenom doses used and length of stay were found to be higher in advanced stages (p<0.05 for each). The rate of antivenom allergy was found to be 7.6%. xi Comparisons based on comorbidity, bite site, and season revealed no significant differences in staging, length of stay, or antivenom dose (p>0.05 for each). However, higher antivenom doses were observed in patients who underwent incorrect prehospital interventions, such as tourniquets, suctioning, and incisions (p<0.001). Patients receiving analgesia were found to be in more advanced stages and had higher length of stay and antivenom doses than patients not receiving analgesia (p<0.05 for each). Fresh frozen plasma (FFP) was administered more frequently in advanced stages (p<0.001). Patients receiving FFP were found to have more antivenom use and longer length of stay (p<0.05 for each). The most common laboratory finding observed in patients was elevated glucose (55.4%). When evaluated by stage, the proportion of patients with low PLT values was higher in advanced stages (p<0.001). Hospitalization duration was significantly longer in patients with elevated WBC, urea, and glucose levels (p<0.05 each). Antivenom administration dose was significantly higher in patients with elevated WBC, urea, and glucose levels, and low PLT (p<0.05 each). The most common sequelae in patients were hemorrhagic blisters. The rate of sequelae was significantly higher in bites on the finger and in patients who received incorrect prehospital management (p<0.05 each). Patients with sequelae had longer hospital stays and longer antivenom doses (p<0.05 each). 20.6% of the patients were informed and discharged after at least 6 hours of follow-up in the emergency department; 77.5% were hospitalized and followed-up; and 2% were referred to advanced centers. CONCLUSION: In our study, snakebite cases were most frequently male, presenting during the summer months, bitten on the upper extremity. Clinical evaluation revealed that stage 1 cases, characterized by edema and pain, were the most common. Our study demonstrated the effects of patient demographics, findings, and treatment on stage, length of hospital stay, and antivenom dose. KEYWORDS: Snakebite, emergency department, antivenom, grading, clinical findings, treatment