No Change in the Use of Antivenom in Copperhead Snakebites in Ohio.

Walker B Plash,Sheila Goertemoeller,Uwe Stolz,Edward J Otten

doi:10.1016/j.wem.2021.03.010

Abstract

Historically, copperhead snake (Agkistrodon contortrix) envenomations were not treated with antivenom owing to related adverse events and little benefit. However, recent studies have shown improved outcomes with antivenom use. We hypothesized that the frequency of antivenom use for copperhead envenomation in Ohio has increased as benefits of administration became more widely known. All copperhead snakebites reported to the Ohio poison control centers from 2006 through 2016 were compiled. Antivenom use, bite severity, and disposition were abstracted. A nonparametric test for trend was used to evaluate changes over time for the number of patients treated with antivenom and patient disposition. Logistic regression was used to assess the odds of admission vs discharge with antivenom administration, bite severity, age, and sex as independent variables. Ninety-eight patients reported copperhead snakebites to the poison control centers. The test of trend showed no change in the proportion of patients treated with antivenom by year (P=0.42). There was no difference in the proportion of patients discharged home (P=0.38) per year. Logistic regression showed antivenom use was associated with an odds ratio for admission of 46.7 (95% CI: 7.3-296.4). The frequency of antivenom use for copperhead bites did not significantly increase between 2006 and 2016. Administration of antivenom was associated with a large increase in the odds of admission to the hospital, even when controlling for bite severity. Further education regarding the benefits and safety of antivenom may increase its use for copperhead snakebites, but may lead to an increase in hospital admissions.

Highlights

Copperhead snake (Agkistrodon contortrix) envenomations were not treated with antivenom owing to related adverse events and little benefit
Increased provider education may lead to increased use of antivenom for copperhead bites, which may lead to decreased use of narcotic pain medication and improved return of limb function
We did not detect any significant changes in the proportion of copperhead snakebites treated with antivenom or amount of antivenom used in the state of Ohio over the years 2006 through 2016

Summary

Introduction

Copperhead snake (Agkistrodon contortrix) envenomations were not treated with antivenom owing to related adverse events and little benefit. Recent studies have shown improved outcomes with antivenom use. We hypothesized that the frequency of antivenom use for copperhead envenomation in Ohio has increased as benefits of administration became more widely known. Copperhead (Agkistrodon contortrix) snakes, a member of the family Crotalidae, are one of the more common, resulting in approximately 2000 ED visits in the United States per year.. Severe crotalid envenomations can result in local tissue destruction, coagulopathy, shock, and death.. In instances of severe envenomation, the decision to use antivenom is fairly straightforward.. Copperhead snake envenomations rarely cause severe symptoms and are almost never fatal.. Most copperhead envenomations result in only local pain, swelling, and ecchymosis, with rare nausea or paresthesias.. Severe crotalid envenomations can result in local tissue destruction, coagulopathy, shock, and death. In instances of severe envenomation, the decision to use antivenom is fairly straightforward. copperhead snake envenomations rarely cause severe symptoms and are almost never fatal. Most copperhead envenomations result in only local pain, swelling, and ecchymosis, with rare nausea or paresthesias. Coagulopathy is often the most concerning symptom of pit viper envenomations.

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