03202nas a2200325 4500000000100000008004100001260001200042653001100054653001100065653004900076653001900125653002400144653001400168653001500182653002400197100001700221700001300238700001300251700001200264700001400276700001400290700001300304700001600317245013400333856007500467300001100542490000700553520230200560022001402862 2026 d c07/202610aSnakes10aVenoms10a Surgical and invasive medical procedures 10a Body limbs 10aDiagnostic medicine10asnakebite10aFasciotomy10aClinical management1 aSteinhorst J1 aAmuasi J1 aWerker P1 aHabib A1 aLavonas E1 aKreuels B1 aLalloo D1 aStienstra Y00aUnder pressure: Clinical management of venom-induced compartment syndrome in snakebite-A scoping review of the global literature. uhttps://pmc.ncbi.nlm.nih.gov/articles/PMC13427016/pdf/pntd.0014536.pdf a1 - 230 v203 a

BACKGROUND:

Venom-induced compartment syndrome (VICS) is a rare but severe complication of snakebite which poses unique challenges in diagnosis and treatment. Published literature largely focuses on VICS in the North American context, while information on clinical presentations, diagnostic and treatment approaches, clinical outcomes and associated challenges from the world's most snakebite endemic regions remain fragmented and scarce.

METHODS:

A scoping review using PRIMSA-ScR methodology of the global literature on VICS was performed by searching the PubMed, Embase, and Cochrane databases. Literature was divided into 1) Case reports on VICS and 2) General literature. Clinical data from eligible case reports was extracted to describe management of VICS and associated challenges. Available evidence on diagnostic and treatment strategies was extracted from the general literature.

RESULTS:

Of 115 cases of VICS analyzed, most were from Europe (40%); Only 13% and 6% were reported from South-East Asia and Africa respectively. Viperids caused 73% of bites and upper extremities were most frequently affected (63%). Compartment pressure was measured in 38% of patients. Compartment pressure was more commonly measured in the 12% of non-surgically treated patients, none of whom developed ischaemic contracture or required amputation. Coagulopathy was the most common systemic toxicity, present in 40% of patients at admission. Results from eight animal studies support the use of antivenom for treating VICS. Analysis of 17 human observational studies suggests an overdiagnosis of VICS using clinical symptoms alone, highlighting the need to investigate diagnostic tools, such as ultrasound, for diagnosing compartment swelling.

CONCLUSION:

Antivenom as first-line treatment for VICS is supported by animal and human observational studies. However, additional data is needed to inform decision-making on when fasciotomy is indicated as a rescue therapy. Improved evidence generation will depend on the collection of high-quality clinical and diagnostic observational data from patients treated with antivenom in snakebite-endemic regions.

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