PROGNOSTIC-SIGNIFICANCE OF CLINICAL GRADING OF PATIENTS ENVENOMED BY BOTHROPS LANCEOLATUS IN MARTINIQUE

The correlation between clinical grading of patients bitten by Bothrop s lanceolatus and the subsequent development of their envenoming was e xamined. Severity of envenoming was graded using a ldr scale (minor to major). Patients were classified into 2 groups according to the time elapsed between bite and treatment with a specific purified equine F(a b')(2) antivenom. The late/no treatment group (n=33) was characterized by a systemic thrombotic complication rate of 14/33 (42.4%) leading t o 4 deaths, which increased with the maximum severity assessed on the first day following the bite (P=0.003). However, infarctions could dev elop in patients who presented initially with signs of moderate enveno ming, normal blood clotting and low serum levels of venom antigens. No such complication or fatality occurred in the early (0.5-6 h) treatme nt group (n=70). Multiple regression analysis showed that duration of stay in hospital in this group increased with the length of the snake (P=0.017), venom antigenaemia (P=0.016), initial grading (P<0.001), an d with the need for surgical debridement (n=10/70, P<0.001). Outcome w as correlated with initial severity of envenoming. However, the only f actor with a positive prognostic significance for the individual enven omed patient was the early infusion of specific antivenom, which led t o 100% recovery in our series.