Decoding Severity in Crotalic Snakebite Cases: Findings From a Decade of Cohort Analysis in Brazil

BACKGROUND: Crotalic snakebite accidents are a common cause of admission into toxicology units in Brazil, and are associated with substantial morbidity and mortality. Our aim was to analyze clinical and laboratory findings, outcomes, and variables associated with the severity of patients treated for crotalic accidents at a reference center in Brazil. METHODS: This retrospective cohort study included consecutive patients treated at a referral center in Minas Gerais state, Brazil, between January 2011 and December 2022. Data were collected from medical records. Descriptive analyses, as well as univariate and multivariate logistic regression analyses, were performed. RESULTS: A total of 415 patients were included (median age 41; interquartile range [IQR] 23-56; 79.5% male). Of these, 67.5% were admitted within 6 h of the incident, and 73.7% of the incidents occurred in rural areas. The median length of hospital stay was 3 days (IQR 2-4); 44.1% of the cases were identified as severe, and four patients died. Factors associated with severity included age ≤ 20 years (OR 2.99; 95% CI 1.65-5.50) or ≥ 50 years (OR 1.79; 95% CI 1.08-2.96), unidentified or unconfirmed snake species (OR 4.18; 95% CI 2.06-8.77 and OR 2.60; 95% CI 1.54-4.44, respectively), and treatment delays > 6 h (OR 4.04; 95% CI 2.46-6.72). CONCLUSION: This study highlights the burden of crotalic snakebite accidents and the need for targeted prevention and timely access to healthcare, particularly for rural populations. Addressing delays in treatment and improving snake identification can reduce the risk of severe outcomes.