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Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment.
J Med Toxicol. 2020 01; 16(1):17-23.JM

Abstract

INTRODUCTION

Few data exist to understand the recovery phase of pit viper envenomation. A recently published placebo-controlled clinical trial affords this opportunity. The purpose of this study is to examine the time course of recovery from copperhead snake (Agkistrodon contortrix) envenomation patients managed with and without the use of antivenom, stratified by age, sex, anatomic site of envenomation, initial severity of envenomation, and geographic region.

METHODS

This is a post-hoc subgroup analysis of data from a multi-center double-blinded clinical trial of Fab antivenom (FabAV) vs. placebo. Outcomes were the Patient-Specific Functional Scale (PSFS) score at 3, 7, 10, and 14 days after envenomation. Least-squares mean PSFS score curves were calculated for each subgroup, and repeated measures ANOVA was used to estimate between-group comparisons.

RESULTS

Seventy-two subjects were included, of whom 44 received FabAV. Males demonstrated better overall recovery than females (model predicted PSFS score 6.18 vs 4.99; difference 1.19; 95% CI 0.12 to 2.25; p = 0.029). No sex difference was found in response to FabAV. Overall recovery and effect of FabAV were similar in adult vs adolescent patients, patients with upper vs lower extremity envenomation, and patients with initially mild vs moderate envenomation signs. Analysis by geographic location was not successful due to ANOVA mode instability.

CONCLUSIONS

Male victims of copperhead snake envenomation demonstrate slightly better recovery than females, but response to Fab antivenom overall is similar across all subgroups studied.

Authors+Show Affiliations

Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. eric.lavonas@dhha.org. Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO, USA. eric.lavonas@dhha.org. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. eric.lavonas@dhha.org.Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.Texas A&M Health Science Center, College Station, TX, USA.Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.Henry J. N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Division of Medical Toxicology, University of Virginia, Charlottesville, VA, USA.Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.Department of Emergency Medicine and Hospital Services, Medical College of Georgia, Augusta, GA, USA.Department of Surgery, Marshall Health, Huntington, WV, USA.Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31482319

Citation

Lavonas, Eric J., et al. "Recovery From Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment." Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, vol. 16, no. 1, 2020, pp. 17-23.
Lavonas EJ, Burnham RI, Schwarz J, et al. Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment. J Med Toxicol. 2020;16(1):17-23.
Lavonas, E. J., Burnham, R. I., Schwarz, J., Quackenbush, E., Lewis, B., Rose, S. R., Greene, S., Toschlog, E. A., Charlton, N. P., Mullins, M. E., Schwartz, R., Denning, D., Sharma, K., Kleinschmidt, K., Bush, S. P., Anderson, V. E., Ginde, A. A., & Gerardo, C. J. (2020). Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment. Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, 16(1), 17-23. https://doi.org/10.1007/s13181-019-00733-y
Lavonas EJ, et al. Recovery From Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment. J Med Toxicol. 2020;16(1):17-23. PubMed PMID: 31482319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment. AU - Lavonas,Eric J, AU - Burnham,Randy I, AU - Schwarz,John, AU - Quackenbush,Eugenia, AU - Lewis,Brandon, AU - Rose,S Rutherfoord, AU - Greene,Spencer, AU - Toschlog,Eric A, AU - Charlton,Nathan P, AU - Mullins,Michael E, AU - Schwartz,Richard, AU - Denning,David, AU - Sharma,Kapil, AU - Kleinschmidt,Kurt, AU - Bush,Sean P, AU - Anderson,Victoria E, AU - Ginde,Adit A, AU - Gerardo,Charles J, Y1 - 2019/09/03/ PY - 2019/04/12/received PY - 2019/08/19/accepted PY - 2019/07/23/revised PY - 2021/01/01/pmc-release PY - 2019/9/5/pubmed PY - 2019/9/5/medline PY - 2019/9/5/entrez KW - Agkistrodon KW - Antivenins KW - Copperhead KW - Envenomation KW - Fab KW - Snake SP - 17 EP - 23 JF - Journal of medical toxicology : official journal of the American College of Medical Toxicology JO - J Med Toxicol VL - 16 IS - 1 N2 - INTRODUCTION: Few data exist to understand the recovery phase of pit viper envenomation. A recently published placebo-controlled clinical trial affords this opportunity. The purpose of this study is to examine the time course of recovery from copperhead snake (Agkistrodon contortrix) envenomation patients managed with and without the use of antivenom, stratified by age, sex, anatomic site of envenomation, initial severity of envenomation, and geographic region. METHODS: This is a post-hoc subgroup analysis of data from a multi-center double-blinded clinical trial of Fab antivenom (FabAV) vs. placebo. Outcomes were the Patient-Specific Functional Scale (PSFS) score at 3, 7, 10, and 14 days after envenomation. Least-squares mean PSFS score curves were calculated for each subgroup, and repeated measures ANOVA was used to estimate between-group comparisons. RESULTS: Seventy-two subjects were included, of whom 44 received FabAV. Males demonstrated better overall recovery than females (model predicted PSFS score 6.18 vs 4.99; difference 1.19; 95% CI 0.12 to 2.25; p = 0.029). No sex difference was found in response to FabAV. Overall recovery and effect of FabAV were similar in adult vs adolescent patients, patients with upper vs lower extremity envenomation, and patients with initially mild vs moderate envenomation signs. Analysis by geographic location was not successful due to ANOVA mode instability. CONCLUSIONS: Male victims of copperhead snake envenomation demonstrate slightly better recovery than females, but response to Fab antivenom overall is similar across all subgroups studied. SN - 1937-6995 UR - https://www.unboundmedicine.com/medline/citation/31482319/Recovery_from_Copperhead_Snake_Envenomation:_Role_of_Age_Sex_Bite_Location_Severity_and_Treatment_ L2 - https://dx.doi.org/10.1007/s13181-019-00733-y DB - PRIME DP - Unbound Medicine ER -
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