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ToxIC Snakebite Registry


ACMT’s North American Snakebite Registry (NASBR) was established in 2013. Data from the first three years of cases were presented at ASM 2017. A review of the epidemiology and clinical characteristics of snakebites in the registry, as well as an overview of acute adverse events that occurred in cases treated with Crotalidae Polyvalent Immune Fab antivenom were presented as platforms. 

Cases were reported to the NASBR from 14 sites distributed throughout 10 states across the country.

  • There were 450 cases, of which 442 were native pit vipers, 5 were non-native venomous snakes, and 3 were Texas coral snakes.
  • 69% of patients were men and 42% of the total population were 18 years of age or younger.
  • There were more lower extremity envenomations (58%) than upper extremity envenomations (42%).
  • Only 19% of bites were reported to result from intentional interactional with the snake.
  • All of these intentional interactions were associated with upper extremity bites and 91% of these involved men.
  • Beginning in 2014, data on footwear was collected for patients with lower extremity bites, and it was learned that 27% of these patients were not wearing shoes, and for those that did wear shoes 64% wore sandals or flip flops.
  • Local, systemic, and hematologic effects were reported in all types of pit vipers, although as expected systemic and hematologic toxicity were more common in rattlesnakes than in copperheads or cottonmouths.
  • 85% of pit viper bites were treated with antivenom but only 2.68% were reported to experience an adverse event following antivenom.
  • Total mean dose of antivenom was 10.5 vials. Twelve patients were readmitted to the hospital after discharge; 11 rattlesnake and one copperhead envenomation.
  • Eight patients were retreated with antivenom; five for late hematologic toxicity and three for local recurrence.

The data presented here is a very superficial overview of the information collected in the registry regarding snake envenomation in North America. In 2016 the NASBR collected an additional 200 snakebite cases and this year is off to a busy start.

We would love to include more sites in the NASBR so please contact if you are interested in participating in ACMT’s ToxIC Registry.

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