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A Comparative Study on the Clinical Features and Complications of Snake Bite Patients in Urban and Rural Areas

도시와 농촌에서 발생한 독사 교상 환자의 임상적 양상과 합병증 비교 연구

  • Hong, Seong-Jun (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Lee, Joo-Hwan (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Choi, Woo-Ik (Department of Emergency Medicine, Keimyung University Dongsan Medical Center) ;
  • Jin, Sang-Chan (Department of Emergency Medicine, Keimyung University Dongsan Medical Center) ;
  • Jeon, Jae-Cheon (Department of Emergency Medicine, Keimyung University Dongsan Medical Center)
  • 홍성준 (대구파티마병원 응급의학과) ;
  • 이주환 (대구파티마병원 응급의학과) ;
  • 최우익 (계명대학교 동산의료원 응급의학과) ;
  • 진상찬 (계명대학교 동산의료원 응급의학과) ;
  • 전재천 (계명대학교 동산의료원 응급의학과)
  • Received : 2020.09.06
  • Accepted : 2020.09.23
  • Published : 2020.09.30

Abstract

Purpose: The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. Methods: A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. Results: Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). Conclusion: Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

References

  1. World Health Organization. Venomous snakes distribution and species risk categories [Internet]. Geneva: World Health Organization [cited 2013 Oct 20]. Available from: http://apps.who.int/bloodproducts/snakeantivenoms/database/default.htm.
  2. Lim H, Kang HG, Kim KH. Antivenom for snake bite in Korea. J Korea Med Assoc 2013;56(12):1091-1103 (Korean) https://doi.org/10.5124/jkma.2013.56.12.1091
  3. Lim CY, Lee JH, Moon TI, Chu YS, Ko TI, Sohn SW, Choi SW, Kim OJ. A case of severe snake bites of the genus Agkistrodon for pediatric patients. J Korean Soc Emerg Med 2004;15(2):128-132 (Korean)
  4. Lyu HG, Kim DK, Choi CS, Baek BC, Jang YU. The management of snake bite. J Korean Surg Soc 1991 Aug;41(2):238-246 (Korean)
  5. Parrish HM, Neser WB, Silberg SL. Copperhead bites in Delaware: results of a survey and suggested treatment. Del Med J 1968;40(6):169-173
  6. Scharman EJ, Noffsinger VD. Copperhead Snakebites: Clinical severity of local effects. Ann Emerg Med 2001;38(1):55-61 https://doi.org/10.1067/mem.2001.116148
  7. Jin SC, Lee JW, Yang SJ, Joo MD, Choi WI. Consideration of factors associated with complications and systemic symptoms of snake bites. J Korean Soc Emerg Med 2008;19(6):686-696 (Korean)
  8. Kang S, Moon J, Chun B. Does the Traditional snakebite severity score correctly classify envenomated patients? Clin Exp Emerg Med 2016;3(1):34-40 (Korean) https://doi.org/10.15441/ceem.16.123
  9. Sajevic T, Leonardi A, Krizaj I. Haemostatically active proteins in snake venoms. Toxicon 2011;57(5):627-645 https://doi.org/10.1016/j.toxicon.2011.01.006
  10. Athappan G, Balaji MV, Navaneethan U, Thirumalikolundusubramanian P. Acute renal failure in snake envenomation: a large prospective study. Saudi J Kidney Dis Transpl 2008;19(3):404-410
  11. Lee BJ, Hong SI, Kim HS, Kim TH, Lee JH, Kim HJ, Ryu BY, Kim HK. Hematological features of coagulopathy and the efficacy of antivenin therapy for a Korean snakebite. J Korean Surg Soc 2007;72(1):18-26 (Korean)
  12. Larreche S, Mion G, Mayet A, Verret C, Puidupin M, Benois A, Petitjeans F, Libert N, Goyffon M. Antivenin remains effective against African Viperidae bites despite a delayed treatment. Am J Emerg Med 2011;29(2):155-161 https://doi.org/10.1016/j.ajem.2009.08.022
  13. Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med 2018;11:209-216 https://doi.org/10.2147/IJGM.S136153
  14. Khina M, Nyuntb T, Ooc NT, Hlad Y. Prognostic indicators in patients with snakebite: Analysis of two-year data from a township hospital in central Myanmar. WHO South-East Asia J Public Health 2012;1(2):144-150 https://doi.org/10.4103/2224-3151.206927
  15. Ozay G, Bosnak M, Ece A, Davutoglu M, Dikici B, Gurkan F, Bosnak V, Haspolat K. Clinical characteristics of children with snakebite poisoning and management of complications in the pediatric intensive care unit. Pediatr Int 2005;47(6):669-675 https://doi.org/10.1111/j.1442-200x.2005.02134.x
  16. Feitosa EL, Sampaio VS, Salinas JL, Queiroz AM, Silva IM, Gomes AA, Sachett J, Siqueira AM, Ferreira LCL, dos Santos MC, Lacerda M, Monteiro W. Older age and time to medical assistance are associated with severity and mortality of snakebites in the Brazilian Amazon: a case control study. PLoS One 2015;10(7):e0132237 https://doi.org/10.1371/journal.pone.0132237
  17. You JS, Chung SP, Kim EC, Lee HS, Kim SH. Survey of the antidote stocking in the emergency medical centers in Korea. J Korean Soc Clin Toxicol 2007;5(2):106-111 (Korean)
  18. Lee BY, Jung SM. A study on related factors use of health information and health literacy among the vulnerable elderly in community. J agric med community health 2018;43(3):147-157 (Korean)
  19. Jeon JC, Lee DH, Kwon GY, Kim SJ. Relation of first aid associated with complications after snake bites. J Korean Soc Clin Toxicol 2009;7(2):105-112 (Korean)