Urban envenomation

Fisher, M. McD.; Bowey, C. J.

doi:10.5694/j.1326-5377.1989.tb136763.x

Cited by 27 publications

(22 citation statements)

References 5 publications

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“…Finally there are difficulties in distinguishing between non‐envenoming spiders and potentially venomous spiders that have a low envenoming rate. There is no doubt that Funnel‐web spiders cause life‐threatening effects in children and the reason for minor effects in all four bites in this study is due to those particular bites not causing envenoming and confirms the suspected 10−20% envenoming rate 23 . Conversely, it is highly unlikely that Huntsman spiders are ever dangerous to humans 24 and the 31 bites in this study by Huntsman spiders that caused no effects or minor effects, confirms this in children.…”

Section: Discussionsupporting

confidence: 73%

Prospective cohort study of definite spider bites in Australian children

Isbister

2004

J Paediatrics Child Health

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Section: Discussionsupporting

confidence: 73%

Prospective cohort study of definite spider bites in Australian children

Isbister

2004

J Paediatrics Child Health

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“…Two studies of hospitalised patients, involving 150 adults and 156 children with definite redback spider bites, demonstrated that 29% and 22%, respectively, had systemic envenomation; 21% of subjects in both studies received antivenom 10 , 17 . In a small prospective study of nine patients with redback spider bites, more than half had severe effects, and eight received antivenom 18 . These three studies, based on emergency department presentations, suffer from sample bias, and patients were not followed up.…”

Section: Discussionmentioning

confidence: 99%

Latrodectism: a prospective cohort study of bites by formally identified redback spiders

Isbister

Gray

2003

Medical Journal of Australia

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Objective: To determine the spectrum of severity and early diagnostic predictors of redback spider bites (Latrodectus hasselti ), and to examine the effect of intramuscular redback antivenom. Design and setting: Prospective cohort study of calls to New South Wales, Queensland and Western Australian poisons information centres and presentations to Royal Prince Alfred Hospital and Royal Darwin Hospital emergency departments. Patients: 68 people with definite redback spider bites in which the spider was immediately collected and expertly identified (1 February 1999 to 30 April 2002). Interventions: Intramuscular redback spider antivenom in a smaller cohort of hospitalised patients. Main outcome measures: Pain severity and duration, local effects and systemic envenomation (effects, prevalence, and persistence > 24 hours). Results: The median duration of effects was 48 hours (interquartile range, 24–96 hours). Pain occurred after all bites and was severe in 42 (62%). Forty‐five patients (66%) had pain lasting longer than 24 hours, and 22 (32%) were unable to sleep because of pain. Systemic effects occurred in 24 (35%). Increasing pain over one hour occurred in 37 cases (54%), and local/regional diaphoresis in 23 (34%); both these features were highly predictive of L. hasselti bites compared with bites of other spiders. One of six patients treated with intramuscular antivenom (17%) had no pain at 24 hours, compared with two of 17 untreated patients (12%) (difference, 5%; 95% CI, –36% to +64%; P = 0.95). There was no difference in duration of systemic effects with antivenom administration. Conclusions: Most redback spider bites cause severe and persistent effects. Intramuscular antivenom appears to be less effective than previously thought and its use by this route needs review.

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“…A large number of cases result from infrequent presentations to many small hospitals, mainly in rural and regional areas. Large urban hospitals usually only see cases of moderate to severe envenoming when they are transferred from smaller centres, and these are often admitted directly to an intensive care unit 3,9 …”

Section: Discussionmentioning

confidence: 99%

“…Despite Australia being host to a large number of venomous animals and having some of the best antivenoms in the world, clinical research into snakebite and envenoming has been fragmented. There have been a few case‐series of snakebite, 3–10 the majority being retrospective and few placing emphasis on attempting to identify caught snakes. There have been far more small case‐series and case reports 11–20 .…”

Section: Introductionmentioning

confidence: 99%

“…Although the majority of previous case‐series have included suspected and definite snakebites 3–10 none has developed specific guidelines for the diagnosis and differentiation of envenoming that are applicable to most EDs or smaller regional or rural hospitals. One study examined the diagnostic value of clinical evidence and coagulopathy in identifying envenomed patients, but this study was of children admitted to a paediatric intensive care unit, so not generalisable to EDs 3 …”

Section: Introductionmentioning

confidence: 99%

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Suspected snakebite: One year prospective study of emergency department presentations

Currie

2003

Emergency Medicine

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Aim: Snakebite is an uncommon, but potentially life‐threatening condition. The more common clinical scenario is suspected snake‐bite. Our aim was to characterise the epidemiology, diagnosis and management of patients with suspected snakebites. Methods: Prospective cohort study of patients presenting with suspected snakebites to a tertiary referral hospital serving a large rural region in tropical northern Australia where a standard admission protocol for suspected snakebites is used. Results: Of 70 suspected snakebite cases, there were 45 definite bites: three severe envenomings (two western brown snakes [Pseudonaja nuchalis] and one mulga snake [Pseudechis australis]); seven mild/moderate envenomings by other snakes, two non‐envenomings by identified P. nuchalis, five bites by identified non‐venomous snakes and 28 definite bites without envenoming. The remaining 25 cases were either suspected bites (8), unlikely bites (15) and two people hit by snakes. Definite snake‐bites occurred throughout the year, peaking in May and December. There were three severe envenomings (mainly coagulopathy), requiring antivenom treatment, but no deaths or major complications. Most patients had appropriate investigations. Of 47 venom detection kit swabs collected, 34 were not tested, venom was not detected in nine and was positive in the three envenomings with one false‐positive tiger snake. Whole blood clotting time was highly sensitive for procoagulant coagulopathy and envenoming in this study. Median length of time from the bite to discharge was 20 h (interquartile range: 12–27). Conclusions: The study shows that although suspected snakebite was common, severe envenoming occurred in less than 5% of cases. The study supports the proposition that a structured approach and admission policy of suspected snakebites leads to the appropriate management of severe envenoming, with no cases discharged early and no cases of non‐envenoming treated with antivenom.

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Urban envenomation

Cited by 27 publications

References 5 publications

Prospective cohort study of definite spider bites in Australian children

Prospective cohort study of definite spider bites in Australian children

Latrodectism: a prospective cohort study of bites by formally identified redback spiders

Suspected snakebite: One year prospective study of emergency department presentations

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