Development and validation of a snakebite severity score for canine Daboia palaestinae envenomation: A prospective multicenter study

Envenomation by Daboia palaestinae is associated with high morbidity and life-threatening complications. This prospective, multicenter study of 205 dogs aimed to develop and validate a clinical snakebite severity score (SSS) to predict mortality and facilitate triage. An initial 15-parameter model was streamlined via univariable logistic regression into a 9-parameter refined SSS (rSSS), incorporating clinical, physical, and laboratory markers. Discriminatory performance was assessed using Area Under the Receiver Operating Characteristic curve (AUROCC). Overall mortality was 6.8% (14/205). Admission rSSS significantly predicted mortality (p < 0.001), with an AUROCC of 0.825 (95% CI: 0.709–0.941). To stratify the cohort into severity groups, a score ≤11 (90% sensitivity) defined the Mild group, and the optimal Youden's Index threshold of ≥17 (71.4% sensitivity, 86.4% specificity) defined the Severe group, with scores of 12–16 constituting the Moderate group. Mortality varied significantly across groups: 0% (0/52) in the Mild group, 3.8% (4/106) in the Moderate group, and 21.3% (10/47) in the Severe group (p < 0.001). High admission scores correlated significantly with antivenom administration (p < 0.001, ρ = 0.349), fresh frozen plasma (p < 0.001, ρ = 0.370), and longer hospitalization (p < 0.01, ρ = 0.180). The rSSS provides an objective framework for prognostic stratification in canine D. palaestinae envenomation. By establishing a high-sensitivity threshold for identifying low-risk patients and stratifying high-risk patients to facilitate escalated intervention, the rSSS offers a resilient triage tool, though future studies are required for external validation and to assess its impact on clinical decision-making.