title: Effectiveness of a clinical protocol implemented to standardize snakebite management in Iran: initial evaluation.
abstract: OBJECTIVE
  This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran.
  
  
  METHODS
  In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P-) in Mashhad Medical Toxicology Centre (MTC). Demographic characteristics and treatment details of all patients were recorded prospectively. Envenomation severity of each victim was assessed according to snakebite severity score (SSS).
  
  
  RESULTS
  After implementation of the protocol, a smaller percentage of patients received antivenom (AV) therapy (78% vs 95%; P=.079). In spite of no significant difference in baseline severity of envenomation between the 2 groups (SSS [mean±SD], 34.8±18.1 vs 35.5±17.4; P=.801), the P+ group received significantly fewer AV vials (8.4±6.8 vs 12.1±5.6 vials; P=.042) and had a significantly shorter length of hospital stay (2.2±1.5 vs 3.2±1.8 days; P=.027). Moreover, smaller proportion of P+ patients experienced recurrence of venom-induced effects; however, the difference was not significant (18.5% vs 36%; P=.159). The reduction in use of antiallergy treatments to prevent or treat acute hypersensitivity reactions approached statistical significance (41% vs 68%; P=.051). These findings denote a reduction in AV use of approximately 4 vials and a reduction in hospital stay of 1 day for each patient, which translates to approximately $196/patient in healthcare cost savings.
  
  
  CONCLUSIONS
  Implementation of a snakebite management protocol at MTC reduced overall antivenom usage, use of antiallergy interventions, and length of hospital stay.
authors.affiliation: AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel); Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari).
authors.forename: Seyed Mostafa
authors.initials: SM
authors.lastname: Monzavi
authors.affiliation: AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel).
authors.forename: Amir Ahmad
authors.initials: AA
authors.lastname: Salarian
authors.affiliation: AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel).
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Khoshdel
authors.affiliation: Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari).
authors.forename: Bita
authors.initials: B
authors.lastname: Dadpour
authors.affiliation: Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari). Electronic address: afsharir@mums.ac.ir.
authors.forename: Reza
authors.initials: R
authors.lastname: Afshari
mesh_terms: D000465:Algorithms; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012909:Snake Bites / Q000453:epidemiology / Q000628:therapy*
chemical_list: D000997:Antivenins
keywords: Iran; antivenoms; clinical protocols; comparative effectiveness research; snakebite