title: An evaluation of snake bites and antivenin use at a regional medical center.
abstract: Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and chi2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs. 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs. 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina 28401, USA.
authors.forename: Larry I
authors.initials: LI
authors.lastname: Watson
authors.forename: Christy
authors.initials: C
authors.lastname: Spivey
authors.forename: Cen Rema
authors.initials: CR
authors.lastname: Menon
authors.forename: Cyrus A
authors.initials: CA
authors.lastname: Kotwall
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Clancy
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012621:Seasons; D012909:Snake Bites / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000997:Antivenins