Journal article
The Australian Snakebite Project, 2005-2015 (ASP-20)
Medical journal of Australia, Vol.207(3), pp.119-125
08/2017
PMID: 28764620
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Abstract
Objective: To describe the epidemiology, treatment and adverse events after snakebite in Australia.
Design: Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005–2015) and data from the National Coronial Information System.
Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation.
Main outcome measures: Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths.
Results: 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7–6.3 hours).
Conclusions: Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.
Details
- Title
- The Australian Snakebite Project, 2005-2015 (ASP-20)
- Creators
- Geoffrey K. Isbister - University of Newcastle AustraliaNicole M Ryan - University of Newcastle AustraliaColin B Page - Calvary Mater Newcastle, Newcastle, NSWNicholas A Buckley - University of Sydney, Sydney, NSWSimon Ga Brown - University of Western Australia, Perth, WAMargaret A O'Leary - University of Newcastle, Newcastle, NSWGeoffrey K Isbister - University of Newcastle Australia
- Publication Details
- Medical journal of Australia, Vol.207(3), pp.119-125
- Publisher
- John Wiley & Sons, Inc.
- Grant note
- National Health and Medical Research Council (NHMRC) Senior Research Fellowship. Grant Number: 1061041 NHMRC Early Career Fellowship Queensland Emergency Medicine Research Foundation Fellowship NHMRC Centre for Research Excellence Grant. Grant Number: 1110343
- Identifiers
- 991013184712702368
- Copyright
- © 2017 AMPCo Pty Ltd. All rights reserved.
- Academic Unit
- Faculty of Health
- Language
- English
- Resource Type
- Journal article