Snakebites in Hajjah, Yemen Republic: Epidemiology, management and the relation of the degree of acuity at presentation with outcome

摘要

Snakebites are a common environmental hazard in many regions of the world. The objectives were to study the epidemiology, clinical, laboratory features of snakebites, the pattern of management with its outcome, and studying the association between the presenting clinical and initial laboratory findings with the outcome. Method: a retrospective, hospital-based study was conducted from March 1997–April 2001 at the Saudi Hospital in the Hajjah governorate, Yemen Republic. The demographics, clinical, laboratory, management, outcome data and selected variables were collected for detecting any association between the degree of acuity of snakebites and the outcome. Results: The data of 186 patients was collected over the period of 4 years. Eighty three percent of snakebite victims were below 40 years of age and males made up 73.7% of all cases. The average incidence was 43 cases per year, with the highest number of cases recorded in July–October. Local swelling then redness was the most common clinical features and the systemic hematological manifestations were double the neurological signs. Lower limbs were involved in 55% of cases. Anemia, leukocytosis, leucopenia and thrombocytopenia were recorded in 34%, 28%, 11% and 8% of cases respectively. Abnormal coagulation was seen in 30% of patients. Admission was necessitated for one third of patients. Surgical assessment was required for 15% of patients. Antivenom was administered for 80% but only 31.7% received this within the first 8 h. Blood products were used for 42% of patients. The complications from the snakebites were recorded in 26% of all cases. There was a statistically significantly association between the rate of complications and the presence of more than three clinical and laboratory findings on arrival. The overall mortality rate was 3.7%. Conclusion: Snakebites are an important public health problem with a relatively high rate of mortalities and other complications associated with delay in the administration of antivenom. Acknowledging more than three clinical and/or laboratory manifestations on arrival to hospital might help in anticipating clinically important complications.