The Epidemiology, Clinical Course, and Management of Snakebites in the North American Snakebite Registry

Abstract

The American College of Medical Toxicology established the North American Snakebite Registry (NASBR), a national database of detailed, prospectively collected information regarding snake envenomation in the United States, in 2013. This report describes the epidemiology, clinical course, and management of snakebites in the NASBR. All cases entered into the NASBR between January 1, 2013 and December 31, 2015 were identified. Descriptive statistics are used to report results. Fourteen sites in 10 states entered 450 snakebites. Native species comprised 99% of cases, almost all of which were pit viper bites. 56.3% were identified as rattlesnakes and 29.4% as copperheads. 69.3% were male and 28.2% were children age 12 and under. Fifty-four percent of bites were on the lower extremity. Twenty-seven percent of patients with lower extremity bites were not wearing shoes. Common tissue findings associated with envenomation were swelling, ecchymosis, and erythema. Systemic effects and hematologic toxicity were more common in rattlesnake than copperhead or cottonmouth envenomations. Crotalidae Polyvalent Immune Fab antivenom was given to 84% of patients. Twelve patients (4.3%) were re-admitted to the hospital after completion of treatment. Eight were re-treated with antivenom. The NASBR gathers detailed data on venomous snakebites across the US. In its initial years, useful information has already been gained. Data regarding footwear will inform public health interventions and education, and information regarding the clinical presentation may help physicians better anticipate effects and manage snakebite. As the number of cases in the NASBR grows, associations between patient-related factors and outcomes may be studied.

Snakebites and climate change in California, 1997–2017

“…The patient demographics of our study were consistent with known epidemiologic trends of snakebites. The predominance of male victims were similar to the 69-79% found in state and national registries [3,18,38]. The average age of our patients was slightly higher than other registry studies [18,38], but similar to those treated in emergency departments [3], with similar fatality rates [39,40].…”

The “T’s” of snakebite injury in the USA: fact or fiction?

“…Male sex has been described as a risk factor for venomous snakebites among regional and national reports, with 69% to 80% of snakebite victims having been reported as male 2–4 13 20–23. Our study found that 65% of snakebite victims were male.…”

“…In 1966, 52% of snakebites were reported among individuals younger than 20 years old, with a rate of 6 snakebites per 100 000 population for children and teenagers aged 5 to 19 37. Existing research concluded that 28% of snakebites affected children less than 12 years old, and that children 0 to 14 years old and 15 to 19 years old accounted for 22% and 9% of all snakebites, respectively 2 4. Our study found that 22% of snakebite victims were aged 0 to 17.…”

“…These upper extremity snakebites may represent encounters where the person was attempting to touch or grasp the snake. In studies that have examined snakebites incurred through intentional contact, more than 90% of victims were males and almost all were associated with upper extremity snakebites 2–4 12 21 24. Unfortunately, NEDS does not capture intentionality at a detailed enough level to assess whether a venomous snakebite victim was trying to touch or grasp a snake versus inadvertently having his or her hand in close proximity to a venomous snake.…”

“…Bites by both indigenous and exotic venomous snakes can result in morbidity and mortality, making snakebites an important public health issue in the USA. Recent studies using national snakebite and injury registries predict 8000 to 10 000 venomous and non-venomous snakebites annually 4 5. During the past 3 years, the American Association of Poison Control Centers (AAPCC) has reported 5000 snakebites per year, one-third of which are venomous 6–8…”