Snakebite mortality at Port Moresby General Hospital, Papua New Guinea, 1992-2001.

Abstract

OBJECTIVE:

Fatal snakebites at Port Moresby General Hospital (PMGH), Papua New Guinea (PNG), were examined to identify interventions that may improve patient survival.

DESIGN:

Retrospective case series.

SUBJECTS AND SETTING:

Inpatients at PMGH who presented with snakebite, had evidence of envenomation, and died as inpatients between 1 January 1992 and 31 December 2001.

OUTCOME MEASURES:

Number and cause of fatalities; ventilation bed-days; antivenom timing, dose and price.

RESULTS:

87 deaths occurred among 722 snakebite admissions to the intensive care unit (ICU). Of these 722 patients, 82.5% were ventilated, representing 45% of all ventilated ICU patients and 60% (3430/5717) of all ICU ventilator bed-days. The median duration of ventilation in fatal snakebite cases was significantly less than in non-fatal cases for children (3.0 v. 4.5 days) and adults (3.0 v. 5.0 days). The case-fatality rate for children (14.6%) was significantly greater than that for adults (8.2%). Sixty fatalities were examined in detail: 75% received blood products; 53% received antivenom (mostly a single ampoule of polyvalent), but only 5% received antivenom < or = 4 hours post-bite. Major causes of death included respiratory complications (50%), probable intracerebral haemorrhage (17%), and renal failure (10%). Antivenom unit costs increased significantly over the decade; in 2000 an ampoule of polyvalent antivenom was 40-fold more expensive in PNG than in Australia on a gross domestic product (A dollars) per capita basis.

CONCLUSIONS:

Management of severe snakebite is a major challenge for PMGH. Improved antivenom procurement and use policies (including increased use of appropriate monovalent antivenoms), combined with targeted snakebite education interventions (community- and hospital-based), are key interventions to reduce the ongoing toll from snakebite.

• Authors: Forbes McGain, Aaron Limbo, David J Williams, Gertrude Didei, Ken D Winkel
• Journal: The Medical journal of Australia (Med J Aust) 2004 Dec 6-20 Vol. 181 Issue 11-12 Pg. 687-91 ISSN: 0025-729X [Print] Australia
• PMID: 15588214 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antivenins

Topics

• Adolescent
• Adult
• Age Distribution
• Aged
• Animals
• Antivenins (therapeutic use)
• Cause of Death
• Child
• Child, Preschool
• Developing Countries
• Emergency Treatment (methods)
• Endemic Diseases
• Female
• Hospitals, General
• Humans
• Incidence
• Male
• Middle Aged
• Papua New Guinea (epidemiology)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Sex Distribution
• Snake Bites (diagnosis, epidemiology, therapy)
• Survival Analysis