Factors affecting prognosis of patients with snakebite cases

Objective: We aimed to determine the factors that affects starting from the pre-hospital area, prolonging hospital stay during the emergency care and admission and outcome of the patients with snake bites in our region . Materials and Methods: 38 patients who admitted to Cukurova University Department of Emergency Medicine between May 2013 and August 2016 were included to this study. Complete blood counts, bleeding diathesis parameters and biochemical tests were evaluated in the blood samples taken at the emergency department of the patients. The patients were clinically staged. he patient's bite-needle time and the length of stay in the hospital, the dose of antivenom , the outcome of patient were recorded. The obtained data were analyzed by SPSS version 17. Findings: Twenty-one of the 38 patients (55.3%) were male and 17 (44.7%) were female. Thirty-five patients were exposed to false first aid, and 30 patients required antibiotics. Soft tissue infection developed in 9 of the patients despite prophylactic antibiotic treatment. The snakebite aws located lower extremşty in 20 of patients , upper extremity in 17 and only one was in thorax region. 9 of our patients were stage 1, 24 were stage 2, 5 were stage 3. Vial antivenom administered to stage 2 was 3.33 ± 1.29, Stage 3 was 4.40 ± 1.14 . Patients with a mean duration of bite-needle time (Antivenom admission time) of 80.92 ± 47.57 minutes were found to have a significantly shorter duration of hospital stay in patients with a short bite needle time. (P = 0, 000) Only one patient developed an allergic reaction to anti-venom. According to BMI, 18 patients were of normal weight (BMI = 25-29,9 kg / m2, 20 patients were overweight class (30-39,9 kg / m2). Overweight patients were found to have a longer stay in the hospital. (P = 0.027) When biochemical parameters were examined, it was found that there was a relation between ALT value and staging (p = 0,032) moreover the duration of hospitalization was higher in patients with lower hemoglobin and platelet values and higher creatinine kinase values (p <0.05). There were no limb lose or mortality in our cases. Results: Even nowadays, in the snake bite cases, the rates of wrong first aid applications such as tourniquet and incision are very high and it is especially important to raise awareness of the people in rural areas. With effective treatment of snake bite, recovery with low dose antivenom has been found, and with the development of production technology in the past years, it has been found that the frequency of antivenom reaction decreases considerably. The shortness of hospitalization in patients with shorter bite needle time and receiving early antivenom therapy shows the importance of antivenom treatment. The length of hospitalization for overweight patients suggests that factors that cause comorbidity in these patients may slow down wound healing. Patients with low platelet and hemoglobin levels and high creatinine kinase values have a longer duration of hospitalization or the association of ALT with clinical severity may be considered as poor prognostic markers. Key Words: Emergency Service, Snake Bite , Prognosis