Victoria E Anderson1, Charles J Gerardo2, Malin Rapp-Olsson1, Sean P Bush3, Michael E Mullins4, Spencer Greene5, Eric A Toschlog6, Eugenia Quackenbush7, S Rutherfoord Rose8, Richard B Schwartz9, Nathan P Charlton10, Brandon Lewis11, Kurt C Kleinschmidt12, Kapil Sharma12, Eric J Lavonas13. 1. a Rocky Mountain Poison and Drug Center , Denver Health and Hospital Authority , Denver , CO , USA. 2. b Division of Emergency Medicine , Duke University School of Medicine , Durham , NC , USA. 3. c Department of Emergency Medicine , Brody School of Medicine , Greenville , NC , USA. 4. d Division of Emergency Medicine , Washington University School of Medicine , St. Louis , MO , USA. 5. e Department of Emergency Medicine , Baylor College of Medicine , Houston , TX , USA. 6. f Department of Surgery , Brody School of Medicine , Greenville , NC , USA. 7. g Department of Emergency Medicine , University of North Carolina , Chapel Hill , NC , USA. 8. h Department of Emergency Medicine , Virginia Commonwealth University , Richmond , VA , USA. 9. i Department of Emergency Medicine and Hospital Services , Medical College of Georgia , Augusta , GA , USA. 10. j Department of Emergency Medicine , University of Virginia , Charlottesville , VA , USA. 11. k Texas A&M Health Science Center , College Station , TX , USA. 12. l Department of Emergency Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA. 13. m Department of Emergency Medicine and Rocky Mountain Poison and Drug Center , Denver Health and Hospital Authority , Denver , CO , USA.
Abstract
BACKGROUND: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. METHODS: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. RESULTS: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p = .025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. CONCLUSIONS: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.
RCT Entities:
BACKGROUND: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. METHODS: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. RESULTS: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p = .025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. CONCLUSIONS: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.
Entities:
Keywords:
Agkistrodon; antivenins; recovery of function; snake bites
Authors: 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 Kleinschmidt; Sean P Bush; Victoria E Anderson; Adit A Ginde; Charles J Gerardo Journal: J Med Toxicol Date: 2019-09-03
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