title: Prospective study of recovery from copperhead snake envenomation: an observational study.
abstract: BACKGROUND
  Although much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.
  
  
  METHODS
  This is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale (PSFS), Work Productivity and Ability Impairment: Special Health Problem (WPAI: SHP), Patients' Global Impression of Change (PGIC), Patient's Global Assessment of Recovery (PGAR), and SF-36 instruments, obtained numeric pain rating scales, and measured grip strength, walking speed, and swelling prior to hospital discharge and 3, 7, 14, 21, and 28 days after envenomation.
  
  
  RESULTS
  20 subjects were enrolled; none were lost to follow-up. Most (80%) had moderate severity swelling, and most (75%) received antivenom. Across the broad range of measures, abnormalities of pain, swelling, impairments of physical and role function, and quality of life persisted for 7-14 days in most subjects. Validated self-reported outcome measures, such as the DASH, LEFS, PSFS, PGIC, SF-36, and the daily activities impairment portion of the WPAI: SHP were more responsive than measurements of swelling or walking speed. Data quality issues limited the utility of the work impairment portion of the WPAI: SHP. Residual signs, symptoms, and impairment in some subjects lasted through the 28-day study period. The study design precluded any assessment of the effectiveness of antivenom.
  
  
  CONCLUSIONS
  Signs, symptoms, impaired function, and decreased quality of life typically last 7 - 14 days after copperhead envenomation. Several tools appear responsive and useful in studying recovery from pit viper envenomation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01651299.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 777 Bannock Street, MC 0180, Denver, CO, 80204, USA. eric.lavonas@rmpdc.org.|Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. eric.lavonas@rmpdc.org.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lavonas
authors.affiliation: Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA. charles.gerardo@duke.edu.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Gerardo
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D057566:Self Report; D012909:Snake Bites / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy
chemical_list: D000997:Antivenins