Purpose
The goal of this study was to evaluate the recent trends in the management of upper
extremity Crotalid envenomation in the state of Georgia, United States.
Methods
A retrospective review of the Georgia Poison Center database looking at the reported
snakebites to the upper extremity between 2015 and 2020 was performed. Patient demographics,
timing and location of injury, severity of envenomation, treatment, including use
of antivenin and surgical intervention, and reported complications related to the
use of antivenin was extracted.
Results
A retrospective review of snakebites between 2015 and 2020 showed 2408 snakebite cases
with a mean patient age of 37.4 years. Males incurred 62.8% of all bites. The highest
incidence was in summer 52.5%, and between the hours of 5 PM to midnight 57.2%. Overall,
1010 (41.9%) of all bites were categorized as venomous snakebites (55.6% copperhead,
20% rattlesnake, 2.4% cottonmouth, and 22% miscellaneous [including 3 Elapid envenomations]
or unidentified. The total number of venomous bites to the upper extremity was 575
(56.9%) and 567 patients received antivenin. Envenomation severity was mild in 29%,
moderate in 45%, severe in 10%, and undetermined in 16% of cases. Crotalidae polyvalent
immune Fab (Ovine) was the main antivenin used, with overall mean initial therapy
dose of 6.2 vials and 59% of patients receiving maintenance therapy. Three patients
(0.5%) had a severe anaphylactic reaction to antivenin requiring cessation of therapy.
Seven patients had acute compartment syndrome of the upper extremity requiring fasciotomy
(3 copperhead, 2 rattlesnake, and 2 unidentified). There was no reported mortality
during this period.
Conclusions
Hand surgeons should be familiar with the management of upper extremity Crotalid envenomation.
Antivenin remains the main treatment for symptomatic patients. Crotalid snakebites
rarely require operative intervention.
Level of evidence
Level IV, Prognostic
Key words
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Article info
Publication history
Published online: June 17, 2022
Accepted:
April 21,
2022
Received:
September 17,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
