Predictors of FabAV use in copperhead envenomation

Ramirez-Cueva, Fatima; Larsen, Adam M; Knowlton, Elise; Baab, Kelsey; Kiehl, Robin Rainey; Hendrix, Amy; Condren, Michelle; Woslager, Megan

doi:10.1080/15563650.2021.2018454

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…Because of this venom variability, the high morbidity and mortality of snakebite envenoming, and the cost of treatment, accurate information about local and regional efficacy of antivenom is needed to optimize clinician decisionmaking. 1,2,3 We write with two observations with respect to this report: Most conspicuously interesting is that the most common complication observed in the study population was acute kidney injury, accounting for 4 of the 10 complications observed in patients bitten by rattlesnakes and 2 of the 3 complications in patients bitten by unidentified snakes. Acute kidney injury is a well-recognized complication of snakebite envenoming in many parts of the world, but not well recognized in the United States and not included as a component of the widely used Snakebite Severity Score (SSS).…”

Section: Acute Kidney Injury As a Complication Of Venomous Snakebite ...mentioning

confidence: 93%

“…If the cost of snakebite treatment was lower, it would not likely be argued that it is being overused. 1,3,6 To that end, it is essential to devise systematic and comparable methods for evaluating and reporting snakebite envenoming such that local, regional, and international data sets can be interpreted to their highest and best purpose to inform clinical decision-making.…”

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confidence: 99%

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Acute Kidney Injury as a Complication of Venomous Snakebite in the United States

Platts‐Mills¹,

Lewin

2022

The American Surgeon™

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Section: Acute Kidney Injury As a Complication Of Venomous Snakebite ...mentioning

confidence: 93%

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confidence: 99%

Acute Kidney Injury as a Complication of Venomous Snakebite in the United States

Platts‐Mills¹,

Lewin

2022

The American Surgeon™

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Repeat antivenom administration following crotalidae immune F(ab’)2 antivenom in Agkistrodon species: a case series

Ryan,

Atti,

Marshall

et al. 2023

Toxicology Communications

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Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children

Rohl,

Meredith,

Anderson

et al. 2024

Pediatr Emer Care

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Objectives In the United States, studies are inconclusive regarding the indications for polyvalent antivenom administration for crotaline envenomation. We compared polyvalent antivenom administration versus observation used at 2 separate institutions. We hypothesized that deferring antivenom leads to increased hospital length of stay and surgical interventions. Methods Retrospective chart review of children who presented to Le Bonheur Children's Hospital (LBCH) in Memphis, Tennessee, and Monroe Carell Jr Children's Hospital at Vanderbilt (MCJCHV) in Nashville, Tennessee, from 2009 to 2021. Patient demographics, treatment utilization, bite location, and outcomes from both sites were statistically examined. Results A total of 183 patients met the inclusion criteria (123 at LBCH, 60 at MCJCHV). At LBCH, mean age was 9.2 years, 54% were male, and 79% of known snakes identified as copperheads. At MCJCHV, mean age was 8.9 years, 65% were male, and 88% of known snakes identified as copperheads. The most commonly envenomated areas for both sites were the foot (42%), hand (27%), and ankle (26%). Patients at LBCH were managed with antivenom only 25% of the time, whereas 75% were observed; 82% of MCJCHV patients were managed with antivenom (P < 0.001). There were no significant differences in length of stay (mean, 1.5 days at LBCH and 1.8 days at MCJCHV; P = 0.136) or surgical intervention (3.3% of LBCH encounters, 5.0% of MCJCHV encounters; P = 0.685). Secondary outcomes aside from coagulopathy and admission location (intensive care unit vs floor) were also not significant. Conclusions The use of antivenom did not impact hospital length of stay or surgical interventions. Our results should be interpreted cautiously as our study reflects regional experiences with snake species in the Southeast United States and not North America as a whole. Other institutional differences in management and smaller n at MCJCHV may have contributed to different outcomes. Further study is needed to determine intermediate and long-term effects of deferring antivenom use.

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Predictors of FabAV use in copperhead envenomation

Cited by 4 publications

References 38 publications

Acute Kidney Injury as a Complication of Venomous Snakebite in the United States

Acute Kidney Injury as a Complication of Venomous Snakebite in the United States

Repeat antivenom administration following crotalidae immune F(ab’)2 antivenom in Agkistrodon species: a case series

Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children

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