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A. Tupetz1, A.J. Phillips1, P.E. Kelly1, L.K. Barcenas1, E.J. Lavonas2, J.R. Nickenig Vissoci1,3, C.J. Gerardo1
1Duke University School of Medicine, Department of Surgery, Durham, United States, 2Denver Health and Hospital Authority, Department of Emergency Medicine, Denver, United States, 3Duke University, Duke Global Health Institute, Durham, United States
Background: Snakebite Envenoming (SBE) affects 1.8 million people annually, with mortality estimated to be between 20,000-125,000 persons per year predominantly in resource poor settings where the human development index, gross domestic product and government expenditure on health are low. Of those surviving, an estimated 400,000 are left living with permanent physical and psychological disabilities. Despite this significant disease burden, there are no theoretical models to describe dysfunction in SBE populations.
Purpose: In this study, we analyze the PSFS activities in SBE patients to construct an International Classification of Functioning, Disability, and Health (ICF) based theoretical model of SBE dysfunction to enhance our understanding of the impact on the daily lives of survivors. The WHO ICF provides a conceptual basis for defining and measuring all aspects of functioning and disability within the biopsychosocial model.
Methods: This study performed a post-hoc analysis of two multi-center, prospective studies, conducted at 22 clinical sites in the United States. All patients in both studies were enrolled in the emergency department, followed through their initial hospital encounter, and returned for outpatient assessments 3, 7, 14, 21, and 28 days after envenomation. Activities listed in the PSFS were used for a combination of qualitative content analysis and Natural Language Processing to categorize responses using the ICF model.
Results: Our sample included 86 patients. The average age was 43.0 (SD 17.6) years, Most had lower extremity injuries (62%). A total of 99 unique activities were chosen by patients when completing the PSFS, representing eight of the nine Activity and Participation domains of the ICF, with the majority in Mobility (38%, eg walking, driving, manipulating objects), General Tasks and Demands (21%, eg house chores, getting out of bed) and Community, social and civic life (14%, eg sports activities, play, hobbies). The majority of the function were coded in multiple domains (93%) out of which 23% related to basic upper extremity functionality (eg. open jar, carry objects, tie shoes, hold items).
Conclusion(s): Our results showed that the main concerns of snake envenomation patients are related to the ability to perform regular activities and to engage in participatory activities in their regular daily activities. The variety of what activities were chosen by the patients highlight the multifaceted impact of snake envenomation on the participants ́ daily activities and participation restrictions.
Implications: We believe that having an SBE specific dysfunction model can be used to inform treatment approaches and improve care of patients on a global scale.
Funding, acknowledgements: The current study was funded is BTG Specialty Pharmaceuticals (Gerardo,PI)
Keywords: Snakebite envenoming, Disability, Function
Topic: Non-communicable diseases (NCDs) & risk factors
Did this work require ethics approval? No
Institution: Duke University
Committee: Duke Health IRB
Reason: The data stems from two multi-center, prospective studies. (NCT #01651299), (NCT 01864200).
All authors, affiliations and abstracts have been published as submitted.
