Yıl: 2018 Cilt: 24 Sayı: 4 Sayfa Aralığı: 343 - 350 Metin Dili: İngilizce DOI: 10.5505/tjtes.2017.99692 İndeks Tarihi: 08-03-2019

Antivenom use in bite and sting cases presenting to a public hospital

Öz:
BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases.METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis.RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital’s emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite theabsence of systemic or local indications (p<0.0001, χ2=80.595).CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was notindicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be madeaware of the updated guidelines and references to raise their knowledge levels.
Anahtar Kelime:

Konular: Adli Tıp Acil Tıp Yoğun Bakım, Tıp Cerrahi Ortopedi

Bir devlet hastanesine başvuran ısırma ve sokma olgularında antivenom kullanımı

Öz:
AMAÇ: Bir ilçe devlet hastanesine başvuran ısırma ve sokma olgularının dağılımı ve akrep sokmalarında ve yılan ısırmalarında antivenom kullanımının değerlendirilmesi. GEREÇ VE YÖNTEM: Devlet hastanesine 2014 yılı içerisinde bildirilen ısırma-sokma olgularının demografik özellikleri, ısırma sokma etkeni, mevsim, başvuru sırasında klinik bulguların ciddiyeti, akrep sokmalarında ve yılan ısırmalarında antivenom kullanımı geriye yönelik olarak değerlendirildi. İstatistiksel analizde ki-kare testi kullanıldı. BULGULAR: Tüm olgular arasında, ısırma ve sokmaların oranı %0.5 idi. Akrep sokma olguları, hastane başvuruların yarısından fazlasını (%54.2) oluştururken, akrep sokmalarını, arı sokmaları (%30.8) ve yılan ısırmaları (%5.5) izliyordu. Semptomsuz hastalarda, gereksiz antihistaminik uygulaması istatistiksel olarak anlamlı oranda yüksekti (p=0.00006). Akrep sokmalarında ve yılan ısırmalarında, sistemik ya da lokal endikasyon olmamasına rağmen antivenom kullanımı anlamlı oranda yüksekti (p<0.0001, χ2 =80.595). TARTIŞMA: Çalışmamızda, akrep sokmalarında ve yılan ısırmalarında, endikasyon olmadığı durumlarda da antivenom kullanıldığını saptadık. Bu nedenle, ısırma sokma olgularının yönetiminde, birinci basamakta çalışan pratisyen hekimlere güncel kılavuzlar ve kaynaklar eşliğinde bilgilendirme amaçlı eğitimler verilmelidir
Anahtar Kelime:

Konular: Adli Tıp Acil Tıp Yoğun Bakım, Tıp Cerrahi Ortopedi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Köse R. The management of snake envenomation: evaluation of twentyone snake bite cases. Ulus Travma Acil Cerrahi Derg 2007;13:307–12.
  • Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila) 2016;54:924–1109. [CrossRef ]
  • Özcan N, İkincioğulları D. Ulusal Zehir Danışma Merkezi. 2008 yılı çalışma raporu özeti. Türk Hijyen ve Deneysel Biyo- loji Dergisi 2009;66:29–58.
  • Yıldıztepe E, Aksay N H, Demir Ö, Arıcı A, Oransay K, Evcim S, Kalkan Ş, Tunçok Y. Analysis of the Year 2007 Data of Dokuz Eylül University Drug and Poison Information Center, Turkey. Turkiye Klinikleri J Med Sci 2010;30:1622–30. [CrossRef ]
  • Ertem K, Esenkaya I, Kaygusuz MA, Turan C. Our clinical experience in the treatment of snakebites. Acta Orthop Traumatol Turc 2005;39:54–8.
  • Goddard J. Physician’s Guide to Arthropods of Medical Importance. 6th ed. Boca Raton, Florida: CRC Press; 2012. [CrossRef ]
  • Goldfrank L, Flomenbaum N, Lewin N, Howland MA,Hoffman R, Nelson L, editors. Goldfrank’s Toxicologic Emergencies, tenth edition, McGraw-Hill, New York, NY; 2013.
  • Warrell DA, Cox TM, Firth JD, editors. Oxford Textbook of Medicine, Vol 2, 2nd ed. Oxford: Oxford University Press 2003:1202–8.
  • Warrell DA. Venomous bites, stings, and poisoning. Infect Dis Clin North Am 2012;26:207–23. [CrossRef ]
  • de Silva HA, Ryan NM, de Silva HJ. Adverse reactions to snake antivenom, and their prevention and treatment. Br J Clin Pharmacol 2016;81:446–52. [CrossRef ]
  • Casey PB, Dexter EM, Michell J, Vale JA. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol 1998;36:215–7. [CrossRef ]
  • Chippaux JP. Emerging options for the management of scorpion stings. Drug Des Devel Ther 2012;6:165–73. [CrossRef ]
  • Warrell DA. Guidelines for the management of snake-bites. Guidelines for the management of snake-bites. WHO Regional Office for SouthEast Asia: 2010. Available at: http://apps.searo.who.int/PDS_DOCS/ B4508.pdf, Accessed 16.04.2018.
  • Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, 1997-2007. JAMA 2010;304:664–70. [CrossRef ]
  • O’Neil ME, Mack KA, Gilchrist J. Epidemiology of non-canine bite and sting injuries treated in U.S. emergency departments, 2001-2004. Public Health Rep 2007;122:764–75. [CrossRef ]
  • Arici A, S. Hocaoglu, N. Tuncok Y. Bites and stings reported to the Dokuz Eylul University Drug and Poison Information Center. Turkish Pharmacology Association, 21st National Pharmacology Congress, 2011, Eskisehir, Turkey.
  • Sinclair CL, Zhou C. Descriptive epidemiology of animal bites in Indiana, 1990-92-a rationale for intervention. Public Health Rep. 1995;110:64– 7.
  • Clark S, Long AA, Gaeta TJ, Camargo CA Jr. Multicenter study of emergency department visits for insect sting allergies. J Allergy Clin Immunol 2005;116:643–9. [CrossRef ]
  • Przybilla B, Ruëff F. Insect stings: clinical features and management. Dtsch Arztebl Int 2012;109:238–48. [CrossRef ]
  • Tuncok Y. Scorpion Sting. Guides for Diagnosis and Treatment in Poisoning. 1st Edition; p. 143–6. The Ministry of Health of Turkey 2007.
  • Theakston RD, Warrell DA, Griffiths E. Report of a WHO workshop on the standardization and control of antivenoms. Toxicon 2003;41:541– 57. [CrossRef ]
  • Ahmed SM, Ahmed M, Nadeem A, Mahajan J, Choudhary A, Pal J. Emergency treatment of a snake bite: Pearls from literature. J Emerg Trauma Shock 2008;1:97–105. [CrossRef ]
  • Şahan M, Taşın V, Karakuş A, Özcan O, Eryiğit U, Kuvandık G. Evaluation of patients with snakebite who presented to the emergency department: 132 cases. Ulus Travma Acil Cerrahi Derg 2016;22:333–7.
  • Açikalin A, Gökel Y, Kuvandik G, Duru M, Köseoğlu Z, Satar S. The efficacy of low-dose antivenom therapy on morbidity and mortality in snakebite cases. Am J Emerg Med 2008;26:402–7. [CrossRef ]
  • Schneir AC, RF. Bites and Stings. 8 ed. Tintinalli JS, J. Ma, O. Yealy, DM. Meckler, GD. Cline, DM., editor: Mc Graw Hill; 2016.
  • Sheikh A, Ten Broek V, Brown SG, Simons FE. H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review. Allergy 2007;62:830–7. [CrossRef ]
  • Choo KJ, Simons FE, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev 2012:CD007596. [CrossRef ]
  • Nuchpraryoon I, Garner P. Interventions for preventing reactions to snake antivenom. Cochrane Database Syst Rev 2000:CD002153.
  • Weinstein S, Dart R, Staples A, White J. Envenomations: an overview of clinical toxinology for the primary care physician. Am Fam Physician 2009;80:793–802.
  • Fung HT, Lam SK, Lam KK, Kam CW, Simpson ID. A survey of snakebite management knowledge amongst select physicians in Hong Kong and the implications for snakebite training. Wilderness Environ Med 2009;20:364–70. [CrossRef ]
  • Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al; Million Death Study Collaborators. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis 2011;5:e1018. [CrossRef ]
  • Rahman R, Faiz MA, Selim S, Rahman B, Basher A, Jones A, et al. Annual incidence of snake bite in rural bangladesh. PLoS Negl Trop Dis 2010;4:e860. [CrossRef ]
APA sahin a, ARICI M, HOCAOĞLU AKSAY N, KALKAN Ş, TUNÇOK Y (2018). Antivenom use in bite and sting cases presenting to a public hospital. , 343 - 350. 10.5505/tjtes.2017.99692
Chicago sahin aynur,ARICI Mualla Aylin,HOCAOĞLU AKSAY NİL,KALKAN Şule,TUNÇOK YESIM Antivenom use in bite and sting cases presenting to a public hospital. (2018): 343 - 350. 10.5505/tjtes.2017.99692
MLA sahin aynur,ARICI Mualla Aylin,HOCAOĞLU AKSAY NİL,KALKAN Şule,TUNÇOK YESIM Antivenom use in bite and sting cases presenting to a public hospital. , 2018, ss.343 - 350. 10.5505/tjtes.2017.99692
AMA sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y Antivenom use in bite and sting cases presenting to a public hospital. . 2018; 343 - 350. 10.5505/tjtes.2017.99692
Vancouver sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y Antivenom use in bite and sting cases presenting to a public hospital. . 2018; 343 - 350. 10.5505/tjtes.2017.99692
IEEE sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y "Antivenom use in bite and sting cases presenting to a public hospital." , ss.343 - 350, 2018. 10.5505/tjtes.2017.99692
ISNAD sahin, aynur vd. "Antivenom use in bite and sting cases presenting to a public hospital". (2018), 343-350. https://doi.org/10.5505/tjtes.2017.99692
APA sahin a, ARICI M, HOCAOĞLU AKSAY N, KALKAN Ş, TUNÇOK Y (2018). Antivenom use in bite and sting cases presenting to a public hospital. Ulusal Travma ve Acil Cerrahi Dergisi, 24(4), 343 - 350. 10.5505/tjtes.2017.99692
Chicago sahin aynur,ARICI Mualla Aylin,HOCAOĞLU AKSAY NİL,KALKAN Şule,TUNÇOK YESIM Antivenom use in bite and sting cases presenting to a public hospital. Ulusal Travma ve Acil Cerrahi Dergisi 24, no.4 (2018): 343 - 350. 10.5505/tjtes.2017.99692
MLA sahin aynur,ARICI Mualla Aylin,HOCAOĞLU AKSAY NİL,KALKAN Şule,TUNÇOK YESIM Antivenom use in bite and sting cases presenting to a public hospital. Ulusal Travma ve Acil Cerrahi Dergisi, vol.24, no.4, 2018, ss.343 - 350. 10.5505/tjtes.2017.99692
AMA sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y Antivenom use in bite and sting cases presenting to a public hospital. Ulusal Travma ve Acil Cerrahi Dergisi. 2018; 24(4): 343 - 350. 10.5505/tjtes.2017.99692
Vancouver sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y Antivenom use in bite and sting cases presenting to a public hospital. Ulusal Travma ve Acil Cerrahi Dergisi. 2018; 24(4): 343 - 350. 10.5505/tjtes.2017.99692
IEEE sahin a,ARICI M,HOCAOĞLU AKSAY N,KALKAN Ş,TUNÇOK Y "Antivenom use in bite and sting cases presenting to a public hospital." Ulusal Travma ve Acil Cerrahi Dergisi, 24, ss.343 - 350, 2018. 10.5505/tjtes.2017.99692
ISNAD sahin, aynur vd. "Antivenom use in bite and sting cases presenting to a public hospital". Ulusal Travma ve Acil Cerrahi Dergisi 24/4 (2018), 343-350. https://doi.org/10.5505/tjtes.2017.99692