Evaluation of Risk Factors of Snake Envenomation and Associated Complications Presenting to Two Emergency Departments in Oman

OBJECTIVES: To assess the risk factors of snake envenomation and the associated complications that patients present with, using data from two different emergency departments in Oman. The secondary aim was to describe the common characteristics of the presenting patients.

METHODS: This multicenter retrospective observational study reviewed all cases presenting with symptoms of snakebite to the emergency departments of Sultan Qaboos University Hospital (tertiary) from March 2016 until August 2017 and Rustaq Hospital (secondary) from August 2015 to August 2017.

RESULTS: A total of 212 cases met the inclusion criteria. Coagulopathy was observed in 82 (38.7%) patients, while 14 (6.6%) had acute kidney injury (AKI) and 5 (2.4%) had external bleeding. Of the patients who developed AKI, 85.7% ( p < 0.001) had encountered the snake in a valley and initially had bleeding from the site of the bite ( p < 0.001) and vomiting ( p < 0.007). The delay in receiving the anti-snake venom (ASV) increased the risk of AKI ( p < 0.016). Of the patients who developed coagulopathy, 47.6% ( p < 0.001) had encountered the snake on a farm and 72.0% ( p < 0.002) received the bite to a lower limb. Increased time from bite to ASV was associated with development of coagulopathy ( p < 0.001). No patient death was recorded.

CONCLUSIONS: The location (terrain) where the snake was encountered was associated with the patient's risk for either AKI or coagulopathy, which suggests the preference of different snake species to different types of habitat. The time elapsed between the bite and the ASV administration was associated with higher risk of development of AKI or coagulopathy.