CLINICAL MANAGEMENT OF SNAKEBITES IN COMMUNITY CARE UNIT: A SINGLE-CENTER RETROSPECTIVE STUDY IN LOPBURI, CENTRAL THAILAND
DOI:
https://doi.org/10.55374/jseamed.v9.204Keywords:
snakebite envenomation, epidemiology, clinical profile, snakebite management, antivenom availability, rural healthcare, ThailandAbstract
Background: Snakebite, a neglected tropical disease, might result in severe clinical outcomes.
Objectives: This study presents a retrospective analysis of snakebite data from a community hospital in Lopburi, Central Thailand, and also assesses snakebite distribution and clinical management to lower mortality and morbidity in the community setting.
Methods: A cross-sectional retrospective study used data from October 1, 2014, to August 30, 2023, to determine the epidemiology, clinical profile, and management of snakebite patients who visited Pattananikom Hospital.
Results: The study included 225 snakebite patients with a median age of 39 (IQR 26-53 years), and 64.4% were male. The responsible species for half of the bite cases were unidentified (54.2%). Among 103 confirmed snakebites with identified species, there were 24 cobras (23.3%), 23 Russell’s vipers (22.3%), 16 green pit vipers (15.5%), 4 Malayan pit vipers (3.9%), 2 Malayan kraits (1.9%), and 34 (33.0%) other nonvenomous snakes. Notably, 10 out of 24 patients (41.7%) encountering cobras were diagnosed with venom ophthalmia. For bites caused by unknown snakes, two patients experienced compartment syndrome, one had dyspnea, and one had ptosis. Thirteen patients, also bitten by unidentified snakes and eligible for antivenom, went untreated due to a shortage of polyvalent antivenom, resulting in referrals. From 2021 to 2023, 20 patients (55.6% of 36) were referred (p=0.026). Of the patients with thrombocytopenia, eight (57.1% of 14) were referred (p=0.001), as were all cases with systemic bleeding, dyspnea, ptosis, or compartment syndrome. Moreover, prophylactic antibiotics (amoxicillin-clavulanate) were routinely prescribed (82.7%).
Conclusion: Snakebites have been referred to more frequently in the last three years. Even though the origins of most cases are unknown and often lead to referrals, there is a notable shortage of polyvalent antivenoms. This scarcity has the potential to delay treatment and increase the risk of mortality. This study highlights the need for improved antivenom access in community hospitals to mitigate delays and reduce mortality.
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