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Time to antivenom administration is not associated with total antivenom dose administered in a copperhead-predominant snakebite population.
Acad Emerg Med. 2015 Mar; 22(3):308-14.AE

Abstract

OBJECTIVES

To prevent unnecessary antivenom administration in crotaline snakebite, observation for progression is recommended for the patient with minor envenomation whose condition is stable and not progressing. The objective of this study was to determine the association between the time from bite to initial antivenom administration (Time(AV)) and the total amount of antivenom administered (Total(AV)) and to determine what proportion of patients did not have progression of the envenomation syndrome and did not receive antivenom.

METHODS

This was a retrospective chart review of patients presenting with crotaline snakebite within 24 hours from 2009 through 2012. Blinded dual-chart abstraction and strict data point definitions were used. Spearman correlation was used to determine the association between Time(AV) and Total(AV). A general linear model was used to examine this association using Time(AV) categorized to early and late administration, adjusted for likely confounders. Confounders included age, extremity involved, initial severity, and year of envenomation.

RESULTS

Ninety-five eligible patients were analyzed with 45 (47%) males and a mean (±SD) age of 36.5 (±21.1) years. Eighty-five (89%) received antivenom, with a median Time(AV) of 3.3 hours (interquartile range [IQR] = 2.5 to 5.2 hours). The median Total(AV) was 10 vials (IQR = 6 to 14 vials). The univariate analysis showed a small but statistically significant decrease in Total(AV) given to patients treated greater than 6 hours from bite (r = -0.26, p = 0.015). The multivariate analysis resulted in no significant relation between early or late Time(AV) and Total(AV) (p = 0.10) after adjustment for confounders. Most minimal envenomation syndromes (80%, or 41 of 51) progressed to moderate grade envenomations.

CONCLUSIONS

Time(AV) was not associated with Total(AV) when adjusted for likely confounders and supports current recommendations to observe for progression in minor envenomation. The majority of envenomations progressed, resulting in only a small proportion of patients not eventually receiving antivenom. The authors recommend observation in an environment where the patient can be adequately reassessed for progression of the envenomation.

Authors+Show Affiliations

The Duke University School of Medicine, Durham, NC.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25728451

Citation

Gerardo, Charles J., et al. "Time to Antivenom Administration Is Not Associated With Total Antivenom Dose Administered in a Copperhead-predominant Snakebite Population." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 22, no. 3, 2015, pp. 308-14.
Gerardo CJ, Evans CS, Kuchibhatla M, et al. Time to antivenom administration is not associated with total antivenom dose administered in a copperhead-predominant snakebite population. Acad Emerg Med. 2015;22(3):308-14.
Gerardo, C. J., Evans, C. S., Kuchibhatla, M., Mando-Vandrick, J., Drake, W. G., Yen, M., Kopec, K., & Lavonas, E. J. (2015). Time to antivenom administration is not associated with total antivenom dose administered in a copperhead-predominant snakebite population. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 22(3), 308-14. https://doi.org/10.1111/acem.12598
Gerardo CJ, et al. Time to Antivenom Administration Is Not Associated With Total Antivenom Dose Administered in a Copperhead-predominant Snakebite Population. Acad Emerg Med. 2015;22(3):308-14. PubMed PMID: 25728451.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Time to antivenom administration is not associated with total antivenom dose administered in a copperhead-predominant snakebite population. AU - Gerardo,Charles J, AU - Evans,C Scott, AU - Kuchibhatla,Maragatha, AU - Mando-Vandrick,Jennifer, AU - Drake,Weiying G, AU - Yen,May, AU - Kopec,Kathryn, AU - Lavonas,Eric J, Y1 - 2015/03/01/ PY - 2014/06/02/received PY - 2014/10/07/revised PY - 2014/10/21/revised PY - 2014/10/24/accepted PY - 2015/3/3/entrez PY - 2015/3/3/pubmed PY - 2015/8/13/medline SP - 308 EP - 14 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 22 IS - 3 N2 - OBJECTIVES: To prevent unnecessary antivenom administration in crotaline snakebite, observation for progression is recommended for the patient with minor envenomation whose condition is stable and not progressing. The objective of this study was to determine the association between the time from bite to initial antivenom administration (Time(AV)) and the total amount of antivenom administered (Total(AV)) and to determine what proportion of patients did not have progression of the envenomation syndrome and did not receive antivenom. METHODS: This was a retrospective chart review of patients presenting with crotaline snakebite within 24 hours from 2009 through 2012. Blinded dual-chart abstraction and strict data point definitions were used. Spearman correlation was used to determine the association between Time(AV) and Total(AV). A general linear model was used to examine this association using Time(AV) categorized to early and late administration, adjusted for likely confounders. Confounders included age, extremity involved, initial severity, and year of envenomation. RESULTS: Ninety-five eligible patients were analyzed with 45 (47%) males and a mean (±SD) age of 36.5 (±21.1) years. Eighty-five (89%) received antivenom, with a median Time(AV) of 3.3 hours (interquartile range [IQR] = 2.5 to 5.2 hours). The median Total(AV) was 10 vials (IQR = 6 to 14 vials). The univariate analysis showed a small but statistically significant decrease in Total(AV) given to patients treated greater than 6 hours from bite (r = -0.26, p = 0.015). The multivariate analysis resulted in no significant relation between early or late Time(AV) and Total(AV) (p = 0.10) after adjustment for confounders. Most minimal envenomation syndromes (80%, or 41 of 51) progressed to moderate grade envenomations. CONCLUSIONS: Time(AV) was not associated with Total(AV) when adjusted for likely confounders and supports current recommendations to observe for progression in minor envenomation. The majority of envenomations progressed, resulting in only a small proportion of patients not eventually receiving antivenom. The authors recommend observation in an environment where the patient can be adequately reassessed for progression of the envenomation. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/25728451/Time_to_antivenom_administration_is_not_associated_with_total_antivenom_dose_administered_in_a_copperhead_predominant_snakebite_population_ L2 - https://doi.org/10.1111/acem.12598 DB - PRIME DP - Unbound Medicine ER -