Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 11 ( November, 2022 ) > List of Articles

Original Article

Bite-to-needle Time – An Extrapolative Indicator of Repercussion in Patients with Snakebite

Thamizhkumaran Jayaraman, Raju Dhanasinghu, Santhanam Kuppusamy, Archana Gaur, Varatharajan Sakthivadivel

Keywords : Antisnake venom, Bite-to-needle time, Complications, Mortality, Snakebite

Citation Information : Jayaraman T, Dhanasinghu R, Kuppusamy S, Gaur A, Sakthivadivel V. Bite-to-needle Time – An Extrapolative Indicator of Repercussion in Patients with Snakebite. Indian J Crit Care Med 2022; 26 (11):1175-1178.

DOI: 10.5005/jp-journals-10071-24344

License: CC BY-NC 4.0

Published Online: 31-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Snakebite is a significant occupational and environmental hazard in tropical countries. The treatment of snakebite includes care of the wound, supportive care, and administration of anti-snake venom (ASV). Time is crucial to reducing the morbidity and mortality of patients. This study aimed to assess the “bite-to-needle time” with morbidity and mortality of snakebites and correlate it. Patients and methods: A total of 100 patients were included. Detailed history included the time since snakebite, bite site, species of snake, and symptoms at presentation, which included level of consciousness, cellulitis, ptosis, respiratory failure, oliguria, and bleeding manifestations. “Bite-to-needle time” was noted. Polyvalent ASV was administered in all patients. Duration of hospitalization and complications, including mortality were noted. Results: The age-group of the study population was 20–60 years. About 68% were males. Krait was the commonest species (40%), and the lower limb was the commonest bite site. Within 6 hours, 36% of patients received ASV, and between 6 and 12 hours, 30%. Patients with a bite-to-needle time of under 6 hours spent less time in the hospital and experienced fewer complications. Patients with bite-to-needle times longer than 24 hours had more ASV vials, complications, hospital-stay length, and death. Conclusion: An increase in bite-to-needle time increases the chances of systemic envenomation, hence, the severity of complications or morbidity and risk of mortality increases. The necessity of timing and the value of administering ASV on time must be emphasized to the patients.

PDF Share
  1. Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, et al. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. Elife 2020;9:e54076. DOI: 10.7554/eLife.54076.
  2. Halesha BR, Harshavardhan L, Lokesh AJ, Channaverappa PK, Venkatesh KB. A study on the clinico-epidemiological profile and the outcome of snakebite victims in a tertiary care centre in southern India. J Clin Diagn Res 2013;7(1):122–126. DOI: 10.7860/JCDR/2012/4842.2685.
  3. Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: A nationally representative mortality survey. PLoS Negl Trop Dis 2011;5(4):e1018. DOI: 10.1371/journal.pntd.0001018.
  4. Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5(11):e218. DOI: 10.1371/journal.pmed.0050218.
  5. Abubakar SB, Habib AG, Mathew J. Amputation and disability following snakebite in Nigeria. Trop Doct 2010;40(2):114–116. DOI: 10.1258/td.2009.090266.
  6. Waiddyanatha S, Silva A, Siribaddana S, Isbister GK. Long-term effects of snake envenoming. Toxins (Basel) 2019;11(4):193. DOI: 10.3390/toxins11040193.
  7. Ahmed SM, Ahmed M, Nadeem A, Mahajan J, Choudhary A, Pal J. Emergency treatment of a snakebite: Pearls from literature. J Emerg Trauma Shock 2008;1(2):97–105. DOI: 10.4103/0974-2700.43190.
  8. Mahendra M, Mujtaba M, Mohan CN, Ramaiah M. Study of delayed treatment perspective of snakebites and their long-term effects in a tertiary care hospital in Balgalkot district of Karnataka. APIK J Intern Med 2021;9(3):153–158. DOI: 10.4103/ajim.ajim_78_20.
  9. Inamdar IF, Aswar NR, Ubaidulla M, Dalvi SD. Snakebite: Admissions at a tertiary health care centre in Maharashtra, India. S Afr Med J 2010;100(7):456–458. DOI: 10.7196/SAMJ.3865.
  10. Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snakebite cases, presented to Emergency Medicine department, Ahmedabad, Gujarat. J Emerg Trauma Shock 2013;6(3):199–202. DOI: 10.4103/0974-2700.115343.
  11. Suchithra N, Pappachan JM, Sujathan P. Snakebite envenoming in Kerala, South India: Clinical profile and factors involved in adverse outcomes. Emerg Med J 2008;25(4):200–204. DOI: 10.1136/emj.2007.051136.
  12. Dorji T. Is anti-snake venom required for all snakebites: A case report. Clin Case Rep 2020;8(1):194–197. DOI: 10.1002/ccr3.2598.
  13. Isbister GK, Maduwage K, Shahmy S, Mohamed F, Abeysinghe C, Karunathilake H, et al. Diagnostic 20-min whole blood clotting test in Russell's viper envenoming delays antivenom administration. QJM 2013;106(10):925–932. DOI: 10.1093/qjmed/hct102.
  14. Deshpande RP, Motghare VM, Padwal SL, Pore RR, Bhamare CG, Deshmukh VS, et al. Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital. J Young Pharm 2013;5(2):41–45. DOI: 10.1016/j.jyp.2013.02.003.
  15. Bhalla G, Mhaskar D, Agarwal A. A study of clinical profile of snakebite at a Tertiary Care Centre. Toxicol Int 2014;21(2):203–208. DOI: 10.4103/0971-6580.139811.
  16. Nigam R, Kosam D, Debbarma M, Murthy M. Retrospective study of neuroparalytic snake envenomation in a tertiary care hospital of Chhattisgarh. J Evol Med Dent Sci 2015;4(71):12414–12422.
  17. Gadwalkar SR, Kumar NS, Kushal DP, Shyamala G, Mohammad MZ, Vishwanatha H. Judicious use of antisnake venom in the present period of scarcity. Indian J Crit Care Med 2014;18(11):722–727. DOI: 10.4103/0972-5229.144014.
  18. Ogunfowokan O. Bite-to-hospital time and morbidity in victims of viper bite in a rural hospital in Nigeria. Afr J Prim Health Care Fam Med 2012;4(1):371. DOI: 10.4102/phcfm.v4i1.371.
  19. Saravu K, Somavarapu V, Shastry AB, Kumar R. Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: An Indian tertiary care hospital-based prospective study. Indian J Crit Care Med 2012;16(4):187–192. DOI: 10.4103/0972-5229.106499.
  20. Harshavardhan L, Lokesh AJ, Tejeshwari HL, Halesha BR, Metri SS. A study on the acute kidney injury in snakebite victims in a Tertiary Care Centre. J Clin Diagn Res 2013;7(5):853–856. DOI: 10.7860/JCDR/2013/5495.2957.
  21. Narvencar K. Correlation between timing of ASV administration and complications in snakebites. J Assoc Physicians India 2006;54: 717–719. PMID: 17212020.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.