title: Large snake size suggests increased snakebite severity in patients bitten by rattlesnakes in Southern california.
abstract: OBJECTIVE
  To correlate rattlesnake size and other characteristics of envenomation with the severity of envenomation.
  
  
  METHODS
  We retrospectively reviewed 145 charts of patients bitten by rattlesnakes in Southern California between 1995 and 2004, measuring Snakebite Severity Scores (SSS) and characteristics of envenomation that might be correlated with snakebite severity, including rattlesnake size, rattlesnake species, patient size, and anatomic location of the bite. Outcomes measured included SSS, complications of envenomation, number of vials of antivenom used, and length of hospital stay.
  
  
  RESULTS
  Of the patients bitten by rattlesnakes, 81% were men, and 79% of bites were on the upper extremities. Fifty-five percent of bites were provoked by the patient, and 44% were unprovoked. Neither location of snakebite nor provocation of snakebite affected the SSS. Only 1 patient had a snakebite without envenomation, and only 1 patient died from envenomation. Rattlesnake size was positively correlated with SSS, and SSS was positively correlated with the number of vials of antivenom used and with the length of hospital stay. Rattlesnake species and patient mass did not affect SSS.
  
  
  CONCLUSIONS
  Larger rattlesnakes cause more severe envenomations, which contradicts popular belief.
authors.affiliation: Lynchburg General Hospital, Lynchburg, VA 24501, USA. donjanes@earthlink.net
authors.forename: Donald N
authors.initials: DN
authors.lastname: Janes
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
authors.forename: Gita R
authors.initials: GR
authors.lastname: Kolluru
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D049628:Body Size; D002140:California / Q000453:epidemiology; D002648:Child; D003435:Crotalid Venoms / Q000506:poisoning*; D017839:Crotalus / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012909:Snake Bites / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms