Prognostic indicators in patients with snakebite: analysis of two-year data from a township hospital in central Myanmar

Abstract

Background: Rural people seek medical treatment for snakebite at peripheral health care facilities.Hence, identification of the characteristics, which can be used at peripheral levels of health careas reliable predictors of mortality, are required.Methods: Hospital records of 101 patients (‎70 males and 31 females)‎ with age ranging from 3to 80 years, admitted to Nahtogyi township hospital in central Myanmar during January 2005 toDecember 2006 were reviewed retrospectively. Binary logistic regression was used for estimatingodds ratio (‎OR)‎ and 95% Confidence Interval (‎CI)‎ for various prognostic indicators of mortality.Results: Almost all snakebites were on extremities; more in legs (‎62%)‎ than hands (‎37%)‎. Most(‎52.5%)‎ bites occurred in the morning (‎4 am to noon)‎. Mean (‎SD)‎ time for bite-to-hospital andbite-to-injection of anti-snake venom (‎ASV)‎ was 134.6 (‎78.6)‎ and 167 (‎187.8)‎ minutes respectively.Eleven cases (‎10.9%)‎ had died. Case fatality ratio (‎CFR)‎ was significantly higher in 39 patientswith un-clotted blood as compared to 62 patients with clotted blood (‎25.6% vs 1.6%, p <0.0005)‎.Significantly higher CFR was observed in 49 patients who received ASV in >2 hours after the bitecompared to 52 cases who received ASV within two hours (‎9.9% vs 0.9%, p <0.0001)‎. Oddsratio of fatality were higher among those who had urine output of <400 ml in the first 24 hours(‎OR 26.4; 95% CI 2.4 to 288.3)‎, un-clotted blood (‎OR 4.6; 95% CI 0.3 to 66.7)‎, bite-to-injectiontime of >2 hours (‎OR 4; 95% CI 0.1 to 219.8)‎ bite-to-hospital time of >2 hours (‎OR 3.1; 95%CI0.1 to 136.3)‎ and bites in the morning (‎OR 2; 95% CI 0.3 to 16.0)‎.Conclusions: Clinical parameters could be used by healthcare providers to identify snakebitepatients for referral, who may have fatal outcome.