Abstract:
Delays in treatment seeking and antivenom administration remain problematic for snake
envenoming. We aimed to describe the treatment seeking pattern and delays in admission
to hospital and administration of antivenom in a cohort of authenticated snakebite patients.
Adults (> 16 years), who presented with a confirmed snakebite from August 2013 to October
2014 were recruited from Anuradhapura Hospital. Demographic data, information on the cir cumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical fea tures, outcomes and antivenom treatment were documented prospectively. There were 742
snakebite patients [median age: 40 years (IQR:27–51; males: 476 (64%)]. One hundred
and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-
120min). Antivenom was administered a median of 230min (IQR:180–360min) post-bite,
which didn’t differ between directly admitted and transferred patients; 21 (8%) receiving anti venom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received
antivenom sooner after admission to Anuradhapura hospital than those directly admitted
(60min [IQR:30-120min] versus 120min [IQR:52-265min; p<0.0001]). A significantly greater
proportion of transferred patients had features of systemic envenoming on admission com pared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had pos itive clotting tests on admission (123/212 [58%] versus 10/43 [23%]; p<0.0001). Sri Lankan
snakebite patients present early to hospital, but there remains a delay until antivenom
administration. This delay reflects a delay in the appearance of observable or measurable
features of envenoming and a lack of reliable early diagnostic tests. Improved early anti venom treatment will require reliable, rapid diagnostics for systemic envenoming.
