Extremity Snakebite in Routine Clinical Practice: Clinical, Laboratory, and Treatment-Timing Characteristics of Patients Managed with and Without Fasciotomy.

Introduction

Severe local envenomation following extremity snakebite may mimic acute compartment syndrome and complicate surgical assessment. We aimed to describe the clinical, laboratory, and treatment-timing characteristics of patients managed with and without fasciotomy.

Methods

This single-center retrospective study included patients with extremity snakebite treated between 2023 and 2025. A six-item clinical profile score was constructed retrospectively to summarize documented local findings: pain at rest, pain with passive motion, delayed capillary refill, marked swelling or tenseness, paresthesia, and motor deficit (1 point for documented presence, 0 for documented absence; range, 0-6). Clinical, laboratory, and treatment-timing characteristics were compared between patients managed with and without fasciotomy; analyses were exploratory and interpreted descriptively.

Results

The overall cohort included 50 patients, six of whom underwent fasciotomy. Antivenom administration was documented in 25 patients, absent in 14, and unknown in 11. The complete-case subset comprised 35 patients, including 21 antivenom-treated patients. Within this subset, patients undergoing fasciotomy had higher clinical profile scores (median, 6 vs. 1) and longer bite-to-presentation intervals (median, 4.5 vs. 2 h; both p < 0.001). No significant between-group difference was detected in emergency department arrival-to-antivenom intervals (p = 0.129). Platelet counts were lower and activated partial thromboplastin time was longer in the fasciotomy group. Median bite-to-fasciotomy and antivenom-to-fasciotomy intervals were 8 and 2 h, respectively.

Conclusions

Patients selected for fasciotomy had more pronounced documented local findings and later presentation. These exploratory associations do not establish surgical necessity or pressure-confirmed acute compartment syndrome; the retrospectively constructed clinical profile score remains descriptive, without established diagnostic validity.