Snake bite; frequency of various clinical presentations of admitted patients and average time to reach hospital

ABSTRACT

To determine the frequency of various clinical presentations of snake bitten admitted patients. Study design: Descriptive case series study. This study was carried out in General Medicine ward, at Medical department of Peoples Medical University and Hospital Nawabshah, from September 2011 to March 2012. This study consisted of 55 patients admitted through the outpatient department, as well as from casualty department of Peoples Medical University and Hospital Nawabshah. Detailed History was taken from all the patients with special regard to type of snake, age, sex, site, time of bite, time lapsed between bite and reaching to hospital. Detailed clinical examination of local features were fang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting, echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure of envenomation. Systemic review was also done to see any co-morbidity. All patients underwent for base line and specific investigations especially clotting time [CT]. Inclusion criteria were that all diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history of snake bite with irrespective of toxicity were included. Patients with history of thorn prick, insect bite were excluded criteria. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 55 patients included in this study, 39 were men [70.9%] and 16 patients were female [29%]; with male to female ratio of 2.41. There was wide variation of age ranging from a minimum of >12 year to 60 year. The mean age was 39 +/- 5.8 years. In our study mostly patients 35[63.63%] reached hospital within 60 minutes followed by 12[21.88%] patients within 30 minutes. 5[9%] patients reached within 90 minutes and one patients reported more than 120 minutes. Symptoms of patients were pain at the bite side in 55[100%], ecchymosis in 18[32.72%], discharge from wound in 9[16.36%], bleeding from gum in 8[4.4%] Nausea and vomiting in 7[12.72%], hematuria in 11[20%], ptosis in 8[14.54%], drowsiness in 5[9%] and respiratory failure in 5[9%]. We conclude that males are commonly affected than females and the farmers and labourers are the most vulnerable section of the population for snake bites. In this study age, presence signs and treatment by faith healers is independent predictors of death in case of snake bite. This may provide important evidence to formulate preventive strategies especially health education