Utilisation of poison information services for paediatric snakebites in rural Sri Lanka

Paediatric snakebites can present substantial diagnostic and therapeutic uncertainty, particularly in rural hospitals where access to specialist toxicology expertise may be limited. Emergency expert advice services may support frontline clinicians, but their utilisation and perceived value remain poorly understood. We conducted a qualitative study among 42 physicians working in four hospitals serving snakebite-endemic regions of Sri Lanka. Eight focus group discussions were conducted at Teaching Hospital Batticaloa, District General Hospital Polonnaruwa, District General Hospital Trincomalee and Teaching Hospital Kurunegala. A semi-structured guide explored circumstances prompting consultation, clinical decision-making, reasons for non-utilisation, perceived benefits, barriers to access and priorities for service improvement. Discussions were audio-recorded, transcribed and analysed thematically using Braun and Clarke's framework. Six interrelated themes were identified. Expert advice was primarily sought in the context of clinical uncertainty, unidentified snakes, severe envenoming, antivenom decisions and complications. Advice was perceived to support critical management decisions, provide reassurance and increase clinicians' confidence, with potential benefits for patient management and avoidance of unnecessary treatment. Utilisation was moderated by the availability of consultants and senior colleagues, with external advice less frequently sought for straightforward cases or when local expertise was readily accessible. Important barriers included limited availability, particularly at night, busy telephone lines, connectivity problems, delayed responses and difficulty identifying the correct contact number. Participants advocated 24-hour and island-wide access, improved communication pathways, regular training, point-of-care educational resources and digital platforms. Expert advice services provide an important layer of specialist decision support for physicians managing paediatric snakebites. Improving accessibility while integrating expert consultation with training, clinical guidance and digital decision-support tools may strengthen snakebite care in rural settings.