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<p>Snakebite affects 5.4 million people globally each year, with 1.8 to 2.7 million cases of envenomation. In India, 90% of snakebites are attributed to the “big four” snakes—saw-scaled viper, Indian cobra, common krait, and Russell’s viper—leading to significant morbidity and mortality. Common complications include gangrene, bleeding, compartment syndrome, and cellulitis. This study aims to identify predictors of local complications to enhance treatment outcomes for venomous snakebite victims. This observational cross sectional study was conducted at Mysore Medical College, including all patients presenting with suspected snakebites to the emergency department between June 2023 and June 2024. Patients were followed until discharge to monitor the development of surgical complications. The study included 100 patients aged 18 to 80, with 75% being men. Hemotoxic snakebites accounted for 86% of cases, with bite-to-needle times ranging from 20&#xa0;min to 3&#xa0;days. Cellulitis developed in 82% of patients, compartment syndrome requiring fasciotomy in 27%, and sepsis in 17%. Elevated white blood cell (WBC) count, neutrophil percentage, and serum creatinine levels were significantly associated with sepsis (<i>p</i> &lt; 0.001, <i>p</i> = 0.028, <i>p</i> &lt; 0.001). Higher prothrombin time (PT), international normalized ratio (INR), and serum creatinine levels were linked to more extensive cellulitis (<i>p</i> = 0.005, <i>p</i> = 0.003, <i>p</i> = 0.040). Increased differential limb girth was strongly associated with severe cellulitis and compartment syndrome (<i>p</i> &lt; 0.001, <i>p</i> = 0.01). ROC curve analysis showed that a differential limb girth of 2.75&#xa0;cm or more could predict the need for fasciotomy with high sensitivity (96.3%) and moderate specificity (77%). Cellulitis involving more than 37.5% of the limb also predicted fasciotomy with high sensitivity (92%) and specificity (90.5%). A clinical risk score was then developed: compartment syndrome risk score: (10.89 × DLG) + (1 × PC) + (4.5 × PN) + (7.8 × INR). Categorizing risk as low risk ≤ 400, moderate risk 401–469, and high risk &gt; 469, internal validity was confirmed with a sensitivity of 81.5% and a specificity of 83.8%. This study identifies key predictors of surgical complications following venomous snakebites, including elevated differential limb girth, percentage of limbs with cellulitis, neutrophil percentage, PT, and INR. The derived predictive risk score enhances clinical decision-making by guiding timely surgical interventions, potentially improving patient outcomes.</p>

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Clinical and Biochemical Predictors of Surgical Complications in Venomous Snake Bite: An Observational Cross Section Study in a Tertiary Care Centre

  • 期刊论文

  • 发表日期：

    2025年3月10日

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  • Akash Nayak S.,
  • Raghuveer M. N.,
  • Abhinandan R.,
  • Sanjana B. Lokesha,
  • Shivananda Nayak B.

摘要

Snakebite affects 5.4 million people globally each year, with 1.8 to 2.7 million cases of envenomation. In India, 90% of snakebites are attributed to the “big four” snakes—saw-scaled viper, Indian cobra, common krait, and Russell’s viper—leading to significant morbidity and mortality. Common complications include gangrene, bleeding, compartment syndrome, and cellulitis. This study aims to identify predictors of local complications to enhance treatment outcomes for venomous snakebite victims. This observational cross sectional study was conducted at Mysore Medical College, including all patients presenting with suspected snakebites to the emergency department between June 2023 and June 2024. Patients were followed until discharge to monitor the development of surgical complications. The study included 100 patients aged 18 to 80, with 75% being men. Hemotoxic snakebites accounted for 86% of cases, with bite-to-needle times ranging from 20 min to 3 days. Cellulitis developed in 82% of patients, compartment syndrome requiring fasciotomy in 27%, and sepsis in 17%. Elevated white blood cell (WBC) count, neutrophil percentage, and serum creatinine levels were significantly associated with sepsis (p < 0.001, p = 0.028, p < 0.001). Higher prothrombin time (PT), international normalized ratio (INR), and serum creatinine levels were linked to more extensive cellulitis (p = 0.005, p = 0.003, p = 0.040). Increased differential limb girth was strongly associated with severe cellulitis and compartment syndrome (p < 0.001, p = 0.01). ROC curve analysis showed that a differential limb girth of 2.75 cm or more could predict the need for fasciotomy with high sensitivity (96.3%) and moderate specificity (77%). Cellulitis involving more than 37.5% of the limb also predicted fasciotomy with high sensitivity (92%) and specificity (90.5%). A clinical risk score was then developed: compartment syndrome risk score: (10.89 × DLG) + (1 × PC) + (4.5 × PN) + (7.8 × INR). Categorizing risk as low risk ≤ 400, moderate risk 401–469, and high risk > 469, internal validity was confirmed with a sensitivity of 81.5% and a specificity of 83.8%. This study identifies key predictors of surgical complications following venomous snakebites, including elevated differential limb girth, percentage of limbs with cellulitis, neutrophil percentage, PT, and INR. The derived predictive risk score enhances clinical decision-making by guiding timely surgical interventions, potentially improving patient outcomes.