Identifying the snake: First scoping review on practices of communities and healthcare providers confronted with snakebite across the world

BackgroundSnakebite envenoming is a major global health problem that kills or disables half a million people in the world’s poorest countries. Biting snake identification is key to understanding snakebite eco-epidemiology and optimizing its clinical management. The role of snakebite victims and healthcare providers in biting snake identification has not been studied globally.ObjectiveThis scoping review aims to identify and characterize the practices in biting snake identification across the globe.MethodsEpidemiological studies of snakebite in humans that provide information on biting snake identification were systematically searched in Web of Science and Pubmed from inception to 2nd February 2019. This search was further extended by snowball search, hand searching literature reviews, and using Google Scholar. Two independent reviewers screened publications and charted the data.ResultsWe analysed 150 publications reporting 33,827 snakebite cases across 35 countries. On average 70% of victims/bystanders spotted the snake responsible for the bite and 38% captured/killed it and brought it to the healthcare facility. This practice occurred in 30 countries with both fast-moving, active-foraging as well as more secretive snake species. Methods for identifying biting snakes included snake body examination, victim/bystander biting snake description, interpretation of clinical features, and laboratory tests. In nine publications, a picture of the biting snake was taken and examined by snake experts. Snakes were identified at the species/genus level in only 18,065/33,827 (53%) snakebite cases. 106 misidentifications led to inadequate victim management. The 8,885 biting snakes captured and identified were from 149 species including 71 (48%) non-venomous species.ConclusionSnakebite victims and healthcare providers can play a central role in biting snake identification and novel approaches (e.g. photographing the snake, crowdsourcing) could help increase biting snake taxonomy collection to better understand snake ecology and snakebite epidemiology and ultimately improve snakebite management.

背景：蛇咬中毒是全球范围内一项重大的公共卫生问题，每年导致或致残全球最贫困国家约五十万人。识别咬伤人的蛇种对于理解蛇咬生态流行病学和优化其临床管理至关重要。全球范围内，蛇咬受害者及医疗保健提供者在咬伤蛇种识别中的作用尚未得到研究。目标：本范围综述旨在识别和描述全球范围内咬伤蛇种识别的实践。方法：从创刊至2019年2月2日，在Web of Science和PubMed中系统检索了提供咬伤蛇种识别信息的人类蛇咬流行病学研究。通过滚雪球搜索、手工检索文献综述和使用Google Scholar进一步扩展了搜索。两位独立审稿人筛选了出版物并记录了数据。结果：我们分析了150篇报告了来自35个国家33,827例蛇咬病例的出版物。平均而言，70%的受害者/旁观者发现了咬伤人的蛇，38%将其捕获/杀死并带到医疗设施。这一做法在包括快速移动、积极觅食的蛇种以及更为隐秘的蛇种在内的30个国家中均有发生。识别咬伤蛇的方法包括蛇体检查、受害者/旁观者对咬伤蛇的描述、临床特征的解读和实验室检测。在9篇出版物中，拍摄了咬伤蛇的照片并由蛇类专家进行了检查。在33,827例蛇咬病例中，仅有18,065例（53%）在物种/属水平上确定了蛇种。106例误识别导致了受害者管理不当。捕获并识别的8,885条咬伤蛇来自149个物种，其中71个（48%）是非毒蛇。结论：蛇咬受害者和医疗保健提供者在咬伤蛇种识别中可以发挥核心作用，而新的方法（例如拍摄蛇的照片、众包）可以帮助增加咬伤蛇分类学的收集，以更好地理解蛇的生态学和蛇咬流行病学，并最终改善蛇咬管理。