Eric J Lavonas1,2,3, Randy I Burnham4, John Schwarz4, Eugenia Quackenbush5, Brandon Lewis6, S Rutherfoord Rose7, Spencer Greene8, Eric A Toschlog9, Nathan P Charlton10, Michael E Mullins11, Richard Schwartz12, David Denning13, Kapil Sharma14, Kurt Kleinschmidt14, Sean P Bush15, Victoria E Anderson4, Adit A Ginde16, Charles J Gerardo17. 1. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. eric.lavonas@dhha.org. 2. Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO, USA. eric.lavonas@dhha.org. 3. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. eric.lavonas@dhha.org. 4. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA. 5. Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 6. Texas A&M Health Science Center, College Station, TX, USA. 7. Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA. 8. Henry J. N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. 9. Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. 10. Division of Medical Toxicology, University of Virginia, Charlottesville, VA, USA. 11. Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA. 12. Department of Emergency Medicine and Hospital Services, Medical College of Georgia, Augusta, GA, USA. 13. Department of Surgery, Marshall Health, Huntington, WV, USA. 14. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 15. Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA. 16. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 17. Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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.
RCT Entities:
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.
Authors: Michael E Mullins; Charles J Gerardo; Sean P Bush; S Rutherfoord Rose; Spencer Greene; Eugenia B Quackenbush; Brandon Lewis; Victoria E Anderson; Kurt C Kleinschmidt; Richard B Schwarz; Nathan P Charlton; Eric A Toschlog; Kapil Sharma; David A Denning; Eric J Lavonas Journal: South Med J Date: 2018-12 Impact factor: 0.954
Authors: Victoria E Anderson; Charles J Gerardo; Malin Rapp-Olsson; Sean P Bush; Michael E Mullins; Spencer Greene; Eric A Toschlog; Eugenia Quackenbush; S Rutherfoord Rose; Richard B Schwartz; Nathan P Charlton; Brandon Lewis; Kurt C Kleinschmidt; Kapil Sharma; Eric J Lavonas Journal: Clin Toxicol (Phila) Date: 2018-09-03 Impact factor: 4.467