J Korean Soc Clin Toxicol.  2017 Jun;15(1):1-10. 10.22537/jksct.2017.15.1.1.

Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department

• Baek IY
• Kim TK
• Jin SC
• Cho WI

• KMID: 2386859
• DOI: http://doi.org/10.22537/jksct.2017.15.1.1

Abstract

PURPOSE
This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings.
METHODS
We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared.
RESULTS
Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017).
CONCLUSION
In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

Keyword

Snake bites; Snake venom; Prognostic predictors

MeSH Terms

Amylases
Creatine Kinase
Critical Care
Emergencies*
Emergency Service, Hospital*
Hospitalization
Humans
Length of Stay
Logistic Models
Multivariate Analysis
Poisoning
Retrospective Studies
Snake Bites*
Snake Venoms
Snakes*
Amylases
Creatine Kinase
Snake Venoms