Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment
| Autor: | Eric A. Toschlog, Victoria E. Anderson, Kurt C. Kleinschmidt, Richard B. Schwartz, Eric J. Lavonas, Brandon Lewis, Adit A. Ginde, Nathan P. Charlton, David Denning, Michael E. Mullins, Charles J. Gerardo, John Schwarz, Randy I. Burnham, Kapil Sharma, Spencer Greene, S. Rutherfoord Rose, Sean P. Bush, Eugenia Quackenbush |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Health Toxicology and Mutagenesis Antivenom Snake Bites Toxicology Placebo Severity of Illness Index Immunoglobulin Fab Fragments 03 medical and health sciences Sex Factors 0302 clinical medicine Double-Blind Method Internal medicine Crotalid Venoms Animals Humans Medicine 030212 general & internal medicine Envenomation biology Antivenins business.industry Age Factors Copperhead Pit viper Repeated measures design 030208 emergency & critical care medicine Recovery of Function Middle Aged biology.organism_classification Clinical trial Treatment Outcome comic_books Original Article Female Analysis of variance Agkistrodon business comic_books.character |
| Zdroj: | J Med Toxicol |
| ISSN: | 1937-6995 1556-9039 |
| DOI: | 10.1007/s13181-019-00733-y |
| Popis: | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13181-019-00733-y) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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