Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment

Eric J. Lavonas, Randy I. Burnham, John Schwarz, Eugenia Quackenbush, Brandon Lewis, S. Rutherfoord Rose, Spencer Greene, Eric A. Toschlog, Nathan P. Charlton, Michael E. Mullins, Richard Schwartz, David Denning, Kapil Sharma, Kurt C Kleinschmidt, Sean P. Bush, Victoria E. Anderson, Adit A. Ginde, Charles J. Gerardo

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Medical Toxicology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Agkistrodon
Antivenins
Snake Bites
Bites and Stings
Recovery
Analysis of variance (ANOVA)
Therapeutics
Analysis of Variance
Placebos
Geographic Locations
Snakes
Controlled Clinical Trials
Least-Squares Analysis
Sex Characteristics
Lower Extremity
Clinical Trials

Keywords

  • Agkistrodon
  • Antivenins
  • Copperhead
  • Envenomation
  • Fab
  • Snake
  • Snake

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Lavonas, E. J., Burnham, R. I., Schwarz, J., Quackenbush, E., Lewis, B., Rose, S. R., ... Gerardo, C. J. (Accepted/In press). Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment. Journal of Medical Toxicology. https://doi.org/10.1007/s13181-019-00733-y

Recovery from Copperhead Snake Envenomation : Role of Age, Sex, Bite Location, Severity, and Treatment. / Lavonas, Eric J.; Burnham, Randy I.; Schwarz, John; Quackenbush, Eugenia; Lewis, Brandon; Rose, S. Rutherfoord; Greene, Spencer; Toschlog, Eric A.; Charlton, Nathan P.; Mullins, Michael E.; Schwartz, Richard; Denning, David; Sharma, Kapil; Kleinschmidt, Kurt C; Bush, Sean P.; Anderson, Victoria E.; Ginde, Adit A.; Gerardo, Charles J.

In: Journal of Medical Toxicology, 01.01.2019.

Research output: Contribution to journalArticle

Lavonas, EJ, Burnham, RI, Schwarz, J, Quackenbush, E, Lewis, B, Rose, SR, Greene, S, Toschlog, EA, Charlton, NP, Mullins, ME, Schwartz, R, Denning, D, Sharma, K, Kleinschmidt, KC, Bush, SP, Anderson, VE, Ginde, AA & Gerardo, CJ 2019, 'Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment', Journal of Medical Toxicology. https://doi.org/10.1007/s13181-019-00733-y
Lavonas, Eric J. ; Burnham, Randy I. ; Schwarz, John ; Quackenbush, Eugenia ; Lewis, Brandon ; Rose, S. Rutherfoord ; Greene, Spencer ; Toschlog, Eric A. ; Charlton, Nathan P. ; Mullins, Michael E. ; Schwartz, Richard ; Denning, David ; Sharma, Kapil ; Kleinschmidt, Kurt C ; Bush, Sean P. ; Anderson, Victoria E. ; Ginde, Adit A. ; Gerardo, Charles J. / Recovery from Copperhead Snake Envenomation : Role of Age, Sex, Bite Location, Severity, and Treatment. In: Journal of Medical Toxicology. 2019.
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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.

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