Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department

독사 교상 환자의 응급실 초기 검사에 따른 예후 예측 인자

  • Baek, In Yeop (Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center) ;
  • Kim, Tae Kwon (Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center) ;
  • Jin, Sang Chan (Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center) ;
  • Cho, Woo Ik (Department of Emergency Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center)
  • 백인엽 (계명대학교 의과대학 동산의료원 응급의학과) ;
  • 김태권 (계명대학교 의과대학 동산의료원 응급의학과) ;
  • 진상찬 (계명대학교 의과대학 동산의료원 응급의학과) ;
  • 최우익 (계명대학교 의과대학 동산의료원 응급의학과)
  • Received : 2017.05.16
  • Accepted : 2017.06.05
  • Published : 2017.06.30
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Abstract

Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

Keywords

References

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