Extremity Snakebite in Routine Clinical Practice: Clinical, Laboratory, and Treatment-Timing Characteristics of...

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.