Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

Levine, Michael; Offerman, Steven R.; Vohra, Rais; Wolk, Brian; Lapoint, Jeff; Quan, Dan; Spyres, Meghan B.; LoVecchio, Frank; Thomas, Stephen

doi:10.1111/acem.13401

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Time from envenomation to first evaluation at a healthcare facility was the same in adults and children: adults Similarly, there was no difference in total amount of antivenom administered to adult and pediatric patients (10 [6-14] vs. 12 [6][7][8][9][10][11][12][13][14][15][16][17][18]; p = 0.32). Adults were more likely to receive antivenom compared with children.…”

Section: Resultsmentioning

confidence: 99%

“…When antivenom is indicated, the initial dose recommended varies based on severity of clinical findings rather than on body weight or age [1,13,14]. However, whether or not additional doses of antivenom are indicated is based on clinical progression of the envenomation and response to treatment, so total dose administered can vary tremendously, and in retrospect can be an indirect, imperfect, measure of severity [5,15]. In a retrospective study by Tanen et al looking at patients with rattlesnake envenomation in Arizona, 44 children under 14 years were compared with 138 adults.…”

Section: Discussionmentioning

confidence: 99%

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When It Comes to Snakebites, Kids Are Little Adults: a Comparison of Adults and Children with Rattlesnake Bites

Levine

Ruha²,

Wolk

et al. 2020

J. Med. Toxicol.

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Background Rattlesnake envenomations are a significant cause of morbidity in the USA. While pediatric rattlesnake envenomations are relatively common, data comparing adult and pediatric patients with rattlesnake envenomations remain limited. Methods This multi-center retrospective study used the North American Snakebite Registry (NASBR), a sub-registry of the Toxicology Investigator's Consortium (ToxIC). All cases of rattlesnake envenomations between January 1, 2013, and December 31, 2017, which were entered into the NASBR, were reviewed. Clinical and laboratory parameters, as well as treatment and outcome measurements, were compared between adult and pediatric patients. Results A total of 420 unique cases were identified, including 94 pediatric patients. Adult patients were more likely to be male (76% vs. 62%; OR 1.98) and sustain upper extremity envenomations (57% vs. 25%; OR 4.4). After adjusting for bite location, adults were more likely to exhibit edema compared with pediatric patients. After controlling for envenomation location, there was no difference in rates of necrosis between adult and pediatric patients. Adults exhibited early hematologic toxicity less frequently than pediatric patients, but there was no difference in the rates of late hematologic toxicity. There were no differences in the rates of hypotension or intubation. Conclusion While adult and pediatric patients have some differences in envenomation characteristics and laboratory parameters, adults and pediatric patients had similar rates of systemic toxicity, severity, length of stay, and late hematologic toxicity.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

When It Comes to Snakebites, Kids Are Little Adults: a Comparison of Adults and Children with Rattlesnake Bites

Levine

Ruha²,

Wolk

et al. 2020

J. Med. Toxicol.

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“…This might be a reason that the follow-up rate at Vajira Hospital was significantly higher than that at Taksin Hospital. This was supported by a study "Assessing the effect of a medical toxicologist in the care of rattlesnake-envenomated patients"; medical toxicologist care can be advantageous for those bitten by venomous snakes [20].…”

Section: Discussionmentioning

confidence: 95%

Green Pit Viper Envenomations in Bangkok: A Comparison of Follow-Up Compliance and Clinical Outcomes in Older and Younger Adults

Othong

Eurcherdkul

Chantawatsharakorn³

2022

Toxins

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We compared older and younger adults envenomated by the green pit viper (GPV) with regard to the following: follow-up compliance, elapsed time between envenomation and emergency department (ED) visit, and clinical/treatment outcomes. This was a two-site retrospective cohort study. We searched hospital electronic medical databases between January 2011 and December 2021. Patients aged 15 and above were eligible if they had a history of snakebite and had at least two VCT and/or platelet count results in their medical records. After the search, 1550 medical records were reviewed and 760 cases were found to be eligible for analysis. In total, 205 cases (27.0%) were ≥60 years old. The median ages in the younger and older groups were 40 (26–51) and 68 (64–75) years, respectively. The median elapsed times from bite to the ED were 47 (30–118) vs. 69 (35–150) min (p-value = 0.001). Overall, 91.3% of all cases were managed as out-patient cases and were eligible for follow-up appointments. The rate of out-patient follow-up at 72 ± 12 h in the older patients was significantly higher (43.2%) than in the younger adult patients (32.4%) (p-value = 0.01). Regarding the clinical/treatment outcomes, the rates of coagulopathy, antivenom administration, and hospital admission were not statistically different between both groups.

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“…The tweetchat format lends itself to attracting a diverse audience and promoting the specialty of medical toxicology. Although we are one of the smallest subspecialities in the USA with only 596 board-certified members, medical toxicologists have demonstrated their value in improving the care of the poisoned patient [13,14]. Promoting our research and expertise through social media can lead to increased recognition of our specialty and may result in attracting additional trainees into toxicology fellowship programs.…”

Section: Discussionmentioning

confidence: 99%

The Virtual Toxicology Journal Club: the Dissemination and Discussion of Noteworthy Manuscripts Using Twitter

et al. 2018

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Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

Abstract: Rattlesnake bite patients treated by a medical toxicologist have a significantly reduced LOS compared to those without direct involvement of a medical toxicologist.

Cited by 6 publications

References 11 publications

When It Comes to Snakebites, Kids Are Little Adults: a Comparison of Adults and Children with Rattlesnake Bites

When It Comes to Snakebites, Kids Are Little Adults: a Comparison of Adults and Children with Rattlesnake Bites

Green Pit Viper Envenomations in Bangkok: A Comparison of Follow-Up Compliance and Clinical Outcomes in Older and Younger Adults

The Virtual Toxicology Journal Club: the Dissemination and Discussion of Noteworthy Manuscripts Using Twitter

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