title: Association of rattlesnake bite location with severity of clinical manifestations.
abstract: OBJECTIVE
  To examine an association between bite location in cases of North American crotalid envenomation and the severity of clinical manifestations.
  
  
  METHODS
  We conducted a retrospective review of prospectively collected data for an experimental trial of crotalid antivenom. Our subjects were otherwise healthy individuals with minimal to moderate North American crotalid envenomation. We compared the severity of envenomation for patients with digit bites distal to the proximal interphalangeal joint and bites more proximal using a previously developed and validated snakebite severity score.
  
  
  RESULTS
  Thirteen subjects were classified as having distal bites and 24 as having proximal bites. At baseline (before antivenom administration), the distal group had a mean severity score of 2.9 +/- 1.1, whereas the proximal group had a mean severity score of 5.0 +/- 2.2 (P = .0024). Patients in the proximal group tended to demonstrate a more rapid initial decline in severity score after receiving antivenom than did the distal group.
  
  
  CONCLUSIONS
  In minimal to moderate North America crotalid envenomation, patients who sustained bites on distal aspects the digits tended to experience less severe clinical manifestations of envenomation. It is possible that an isolated bite to the distal aspect of a finger is an early marker of minimal envenomation.
authors.affiliation: San Diego Regional Poison Center, CA, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Moss
authors.forename: G
authors.initials: G
authors.lastname: Bogdan
authors.forename: R C
authors.initials: RC
authors.lastname: Dart
authors.forename: S P
authors.initials: SP
authors.lastname: Nordt
authors.forename: S R
authors.initials: SR
authors.lastname: Williams
authors.forename: R F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D017839:Crotalus; D005260:Female; D005383:Finger Injuries / Q000209:etiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012909:Snake Bites / Q000145:classification