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Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests

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 presen...

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Autores principales: Silva, Anjana, Hlusicka, Jiri, Siribaddana, Nipuna, Waiddyanatha, Subodha, Pilapitiya, Senaka, Weerawansa, Prasanna, Lokunarangoda, Niroshan, Thalgaspitiya, Sujeewa, Siribaddana, Sisira, Isbister, Geoffrey K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728389/
https://www.ncbi.nlm.nih.gov/pubmed/33253208
http://dx.doi.org/10.1371/journal.pntd.0008914
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author Silva, Anjana
Hlusicka, Jiri
Siribaddana, Nipuna
Waiddyanatha, Subodha
Pilapitiya, Senaka
Weerawansa, Prasanna
Lokunarangoda, Niroshan
Thalgaspitiya, Sujeewa
Siribaddana, Sisira
Isbister, Geoffrey K.
author_facet Silva, Anjana
Hlusicka, Jiri
Siribaddana, Nipuna
Waiddyanatha, Subodha
Pilapitiya, Senaka
Weerawansa, Prasanna
Lokunarangoda, Niroshan
Thalgaspitiya, Sujeewa
Siribaddana, Sisira
Isbister, Geoffrey K.
author_sort Silva, Anjana
collection PubMed
description 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 circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, 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 antivenom 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 compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive 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 antivenom treatment will require reliable, rapid diagnostics for systemic envenoming.
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spelling pubmed-77283892020-12-17 Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests Silva, Anjana Hlusicka, Jiri Siribaddana, Nipuna Waiddyanatha, Subodha Pilapitiya, Senaka Weerawansa, Prasanna Lokunarangoda, Niroshan Thalgaspitiya, Sujeewa Siribaddana, Sisira Isbister, Geoffrey K. PLoS Negl Trop Dis Research Article 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 circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, 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 antivenom 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 compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive 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 antivenom treatment will require reliable, rapid diagnostics for systemic envenoming. Public Library of Science 2020-11-30 /pmc/articles/PMC7728389/ /pubmed/33253208 http://dx.doi.org/10.1371/journal.pntd.0008914 Text en © 2020 Silva et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Silva, Anjana
Hlusicka, Jiri
Siribaddana, Nipuna
Waiddyanatha, Subodha
Pilapitiya, Senaka
Weerawansa, Prasanna
Lokunarangoda, Niroshan
Thalgaspitiya, Sujeewa
Siribaddana, Sisira
Isbister, Geoffrey K.
Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title_full Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title_fullStr Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title_full_unstemmed Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title_short Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests
title_sort time delays in treatment of snakebite patients in rural sri lanka and the need for rapid diagnostic tests
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728389/
https://www.ncbi.nlm.nih.gov/pubmed/33253208
http://dx.doi.org/10.1371/journal.pntd.0008914
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