title: Incidence of fatal snake bite in Australia: A coronial based retrospective study (2000-2016).
abstract: BACKGROUND
  It has been over 20 years since a national review of recorded deaths from snake envenoming. The present study aimed to provide an updated review of the epidemiology of deaths from snake bites in Australia.
  
  
  METHODS
  Deaths were identified from January 2000 to December 2016 from the National Coronial Information System. Cases identified due to snakes were extracted with data on coronial findings, autopsy and police records.
  
  
  RESULTS
  Thirty five deaths (2.2 per year) were ascribed or antecedent to a snake bite. Sixteen cases were attributed to snake bite/envenoming as leading directly to death, with other direct causes of death being multiple organ failure (n = 3), intracerebral haemorrhage (n = 2), cerebral hypoxia or anoxia (n = 3), cardiac arrest (n = 1), complications of snake bite (n = 3) or brain stem death (n = 1). Four cases did not have a snake bite indicated in the case history, with an initial diagnosis of either hyperthermia, stroke, gastroenteritis and a horse accident. The median age was 46.5 years (range 1.5-70 years), and 74% were males (n = 25). The time from bite to death varied from 1 h to 19 days. Fifty four percent of bites occurred at the person's residence (n = 1), with 17 being in an urban environment.
  
  
  CONCLUSIONS
  Death from snake bite remains rare in Australia, and has maintained a steady rate for over 20 years. Usually considered a 'rural issue', and with varying recorded causes of death, a nationally co-ordinated effort to further review the national picture of envenoming in Australia can inform education and resource needs within state and local contexts.
authors.affiliation: Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Australia. Electronic address: ronelle.welton@unimelb.edu.au.
authors.forename: Ronelle E
authors.initials: RE
authors.lastname: Welton
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: Royal Melbourne Hospital, University of Melbourne, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Braitberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population; D012909:Snake Bites / Q000150:complications / Q000401:mortality*; D014505:Urban Population; D055815:Young Adult
keywords: Australia; Envenoming; Mortality; Snake