Introduction: Snakebite envenoming is a significant public health problem in rural tropical regions, often resulting in disability and death. Timely hospitalization and prompt administration of antivenom are crucial for survival. However, factors such as limited awareness, poor access to healthcare, antivenom therapy, and reliance on traditional healers contribute to delays in seeking medical care, thereby increasing complications and adverse outcomes.
Methods:  This cross-sectional analytical study aimed to evaluate pre-hospital delay, its associated factors, and related complications among patients with snake envenomation presenting to the emergency department of a tertiary care public center in South India, from August 2023 to May 2024. This study included 100 adult participants with confirmed snakebite characteristics. Participants were selected through consecutive sampling, and data collection focused on details of the snakebite incident, time of hospital presentation, causes of delay, and complications. The data were analysed using mean ± standard deviation, median (interquartile range), and associations were tested using the Chi-square test, Fisher’s exact test, and the Mann-Whitney U test.
Results:  In our study, 18% of participants arrived at the hospital more than 4 hours after envenomation, with a median arrival time of 90 minutes. Among the study participants, prehospital practices included washing the bite site with soap and water (n = 19, 19%) and application of native concoctions (n = 17, 17%). Lack of awareness and knowledge regarding snakebite contributed to delayed hospital arrival. On the first day of admission, the most common complications were leukocytosis (83%), dyselectrolytemia (n =70, 70%) hepatic dysfunction (n = 56, 56%) renal dysfunction (n = 57, 57%), haematuria (n = 48, 48%), and metabolic acidosis (n = 45, 45%). Delayed presentation was significantly associated with higher rates of complications like hematuria (p = 0.003), renal dysfunction (p = 0.008),  metabolic acidosis (p = 0.047)
Conclusion: The current study revealed that traditional practices, combined with a lack of awareness about bites, socioeconomic constraints, and the absence of a guardian, often lead to delayed medical care. These delays result in longer hospital stays, increased morbidity, and higher mortality. Early hospitalization can significantly reduce complications, disability, and mortality in patients with snake envenomation.