Clinico-Epidemiological Profile and Outcome of Snake Bite Cases Admitted in a Tertiary Care Centre in South India

BACKGROUND Snake bite is an important life-threatening emergency but often neglected public health problem in India. India being a subtropical country, has been a land of poisonous snakes, especially in Southern India poisonous snakes like Russell's Viper, Cobra, Krait and Saw Scaled Viper are commonly encountered. In India around 50,000 people are dying every year from snake bites. In spite of these, the true scale of mortality and morbidity from snakebite remains uncertain. We wanted to study the pattern of envenomation and dry bite among the snake bite cases admitted in Government Vellore Medical College Hospital for the period Jan 2018-Jan 2019, describe the clinicoepidemiological profile and outcome of snake bite cases. We also wanted to evaluate the predictive factors of mortality among snakebite cases admitted in a tertiary care centre in Vellore, South India. METHODS A retrospective descriptive analysis of data extracted from medical records of 522 snakebite cases admitted in the Medical wards and IMCU at Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, during the period extending from January 2018 to January 2019 was done, to describe Clinico-epidemiological profile and management of snake bite cases. We described age/gender distribution, seasonal trends of snake bite cases. We computed proportion of envenomation, dry bite and case fatality rate. Among envenomation we analysed the trends in antisnake venom (ASV) usage and its clinical outcome. Statistical analysis was done using Epi Info - Version 7.2 software. RESULTS Of the total 522 snake bite cases admitted in the hospital during the period from Jan 2018 to Jan. 2019, it was found that the median age of the snake bite victim was 40 years (range 13-76). Snakebite cases were higher among male (56%), agriculture worker (47%), rural population (92%) and during monsoon July-October (65%). Sixty percent of the bites occurred in ankle and foot. Species of snake was identified in 23 (4%) cases. The proportion of dry bite and envenomation were 46% and 54% respectively. Of the envenomation cases 20% were haemotoxic, 24% were neurotoxic and 10% were local envenomation. The median duration of hospital stay among envenomation cases was 4 (range 1-20) days and interval between bite and ASV administration was 4 (range 1-48) hours. Sixty cases (13%) were allergic to ASV. Case fatality was 2.5 %(13/522). CONCLUSIONS Effective management of snakebites would include early admission to a hospital, appropriate ASV administration and early identification of the warning signs. Delay in hospitalization is associated with poor prognosis and increased mortality rate due to consumptive coagulopathy, renal failure and respiratory failure.