Epidemiology of snakebites from a general hospital in Singapore: A 5-year retrospective review (2004-2008)

Abstract

Introduction: This is a retrospective study on the epidemiology of snakebites that were presented to an emergency department (ED) between 2004 and 2008. Materials and Methods: Snakebite cases were identified from International Classification of Diseases (ICD) code E905 and E906, as well as cases referred for eye injury from snake spit and records of antivenom use. Results: Fifty-two cases were identified: 13 patients witnessed the snake biting or spitting at them, 22 patients had fang marks and/or clinical features of envenomations and a snake was seen and the remaining 17 patients did not see any snake but had fang marks suggestive of snakebite. Most of the patients were young (mean age 33) and male (83%). The three most commonly identified snakes were cobras (7), pythons (4) and vipers (3). One third of cases occurred during work. Half of the bites were on the upper limbs and about half were on the lower limbs. One patient was spat in the eye by a cobra. Most of the patients (83%) arrived at the ED within 4 hours of the bite. Pain and swelling were the most common presentations. There were no significant systemic effects reported. Two patients had infection and 5 patients had elevated creatine kinase (>600U/L). Two thirds of the patients were admitted. One patient received antivenom therapy and 5 patients had some form of surgical intervention, of which 2 had residual disability. One patient had heparin instilled in the eye for eye injury from cobra spit. Conclusions: Snakebite infrequently presents to the ED. Most of the patients developed local effects that do well with supportive treatment.