From 1995 through 2004, there were 399 non-native exposures in the TESS database. Of these, 350 snakes (87%) were identified by genus and species, comprising at least 77 different varieties. Roughly equal percentages of snakes originated in Asia, Africa and Latin America, with a smaller number from the Middle-East, Australia, and Europe. Nearly half were viperids and a little more than a third were elapids. The vast majority of exposed individuals were adults. However, almost 15% were aged 17 years or less, and almost 7% were children aged 5 years or younger. Eighty-four percent were males. The vast majority of exposures occurred at the victim's own residence. Over 50% were evaluated at a healthcare facility, with 28.7% admitted to an ICU. Overall, 26% of patients were coded as receiving antivenom treatment. Coded outcomes were similar between viperid and elapid envenomations. There were three deaths, two involving viperid snakes and one elapid. Enhancements to the TESS database are required for better precision in and more complete characterization of non-native snake envenomations.

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Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82-91), and the specificity was 76% (95% CI 74-77). The negative likelihood ratio was 0.18 (95% CI 0.12-0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions. RÉ SUMÉObjectif: Les urgentologues devraient ê tre en mesure d'é carter l'existence de lé sions, importantes sur le plan clinique, de la colonne cervicale en s'appuyant sur leurs compé tences cliniques et l'imagerie. L'é tude visait à dé terminer si les urgentologues pouvaient é carter correctement l'existence de lé sions, importantes sur le plan clinique, de la colonne cervicale sur le plan clinique à l'aide de l'imagerie par tomodensitomé trie de la colonne cervicale. Mé thode: Quinze urgentologues ont accepté d'interpré ter un é chantillon de 50 tomodensitogrammes (TDM) de la colonne cervicale en milieu non clinique; l'é chantillon comptait 30% de cas de lé sion de la colonne cervicale. Aprè s une sé ance de formation de 2 heures, les participants ont interpré té les TDM et les ont classé s en deux caté gories: lé sion possible et absence de lé sion. Les participants devaient pré ciser le siè ge des lé sions et leur type. L'interpré tation de ré fé rence reposait sur l'avis de deux radiologistes, membres du personnel. Ré sultats: Les urgentologues ont bien identifié 182 cas de lé sion de la colonne cervicale sur 210. La sensibilité des urgentologues é tait de 87% (intervalle de confiance [IC] à 95% 82-91) et la spé cificité de 76% (IC à 95% 74-77). Le quotient de vraisemblance né gatif s'est é tabli à 0.18 (IC à 95% 0.12-0.25). Conclusions: Les urgentologues expé rimenté s ont ré ussi à identifier, dans une grande proportion, les lé sions de la colonne cervicale sur les TDM; toutefois, la sensibilité n'é tait pas suffisamment é lev...