A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

Authors

  • Sonai Mandal Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Ananya Mandal Department of Pharmacology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
  • Tamoghna Maity Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India
  • Somenath Das Department of Pharmacology, Bankura Sammilani Medical College, Bankura, West Bengal, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20192571

Keywords:

Anti snake venom, Hematotoxic envenomation, Neurotoxic envenomation, Snake bite, Standard treatment guidelines

Abstract

Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.

Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.

Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).

Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.

Metrics

Metrics Loading ...

References

Avau B, Borra V, Vandekerckhove P, De Buck E. The treatment of snake bites in a first aid setting: a systematic review. PLoS Negl Trop Dis 2016;10(10): e0005079.

Mohapatra B, Warrel DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM et al. Million Death Study Collaborators. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5(4):e1018.

Chippaux JP. Snakebite envenomation turns again into a neglected tropical disease! Journal of Venomous Animals and Toxins including Tropical Diseases 2017;23(1):38.

Sarkhel S, Ghosh R, Mana K, Gantait Ket. A hospital based epidemiological study of snakebite in Paschim Medinipur district, West Bengal, India Toxicol Rep. 2017;4:415-9.

WHO Model Lists of Essential Medicines. Available at: https://www.who.int/medicines/publications/essentialmedicines/en/ Accessed on 28th March 2019.

Ghosh S, Maisnam I, Murmu BK, Mitra PK, Roy A, Simpson ID. A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India. Wilderness Environ Med. 2008;19(4):267-74.

Standard Treatment Guidelines on Snakebite. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India With Technical Support from National health Systems Resource Centre; 2016. Available at: http://www.nhm.gov.in/nrhm-instate/520-standard-treatment-guidelines.html Accessed on 28th March 2019.

Dan S, Mandal A, Das A, Chakrabarty S, Gangopadhyay T. A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India. Int J Basic Clin Pharmacol. 2018;7:2047-52.

Pal A, Mukherjee S. Clinical profile and outcome of snake bite in patients attending a tertiary care hospital in Bankura, West Bengal IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2018;17:34-9.

Majumder D, Sinha A, Bhattacharya SK, Ram R, Dasgupta U, Ram A. Epidemiological profile of snake bite in South 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Indian J Public Health. 2014;58(1):17-21.

Mandal S, Mandal A, Chatterjee Y, Das S, Kundu S, Naser SM. A prospective analysis of adherence to standard treatment guidelines in management of snakebite in a tertiary care teaching hospital of rural Bengal, India. Int J Basic Clin Pharmacol. 2019;8:849-55.

Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Ind Pediatrics. 1994; 31:1239-43.

Daswani BR, Chandanwale AS, Kadam DB, Ghonghane DB, Ghorpade VS, Manu HC. Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases. Journal of Clinical and Diagnostic Research. 2017;11(9):FC17-FC21.

Rashmi RD, Jhuma S, Nishanth D. High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review. Indian J Crit Care Med. 2015;19(6):340-9.

Anil A, Singh S, Bhalla A, Sharma N, Agarwal R, Simpson ID. Role of neostigmine and polyvalent antivenom in Indian common krait (Bungarus caeruleus) bite. Journal of Infection and Public Health. 2010;3(2):283-7.

Patrão-Neto FC, Tomaz MA, Strauch MA, Monteiro-Machado M, Rocha-Junior JR, Borges PA, et al. Dexamethasone antagonizes the in vivo myotoxic and inflammatory effects of Bothrops venoms. Toxicon. 2013 Jul 1;69:55-64.

Downloads

Published

2019-06-24

How to Cite

Mandal, S., Mandal, A., Maity, T., & Das, S. (2019). A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital. International Journal of Basic & Clinical Pharmacology, 8(7), 1547–1553. https://doi.org/10.18203/2319-2003.ijbcp20192571

Issue

Section

Original Research Articles