Background: Snake envenomations cause significant morbidity and mortality. The goals of this study were to assess the epidemiology of snakebites in Kentucky and treatment strategies used by physicians reporting to the Kentucky Regional Poison Control Centers (KRPCC).
Methods: This was a descriptive epidemiological study compiling clinical data on snakebites reported to KRPCC from 2011-2016. We built a database of the demographics, treatment, and clinical course of each snakebite reported in the study period. We paid special attention to all antivenin interventions and use of contraindicated therapeutic decisions.
Results: We compiled 674 total records. The mean age was 34 years, with males (71%) predominating. Most (96.5%) bites were to a distal upper or lower extremity. The majority (77.9%) occurred at a private residence. Most reports came between May and September (87.5%). Of the 674, 23.6% (n=159) patients were classified as moderate or severe. Two hundred and thirty (34.1%) patients were admitted to the hospital, 69 to the ICU. Forty-six patients (7.1%) received surgical consults while twelve (1.9%) underwent surgical intervention. 153 patients received antivenin with an average number of 5.6 vials used per patient. Overall average length of stay (LOS) was 2.3 days; mean LOS was 2.7 days and 2.1 days if antivenin was administered or not administered, respectively. Six cases of coagulopathy were noted (INR> 2). Classically contraindicated therapies including empiric antibiotic administration (146), application of ice (28), NSAID or aspirin administration (20), tourniquet application (19), steroids (16), and incision (5) were noted.
Conclusion: Snake envenomations continue to be a prevalent public health concern for residents of Kentucky, chiefly during summer months. Significant medical intervention is being performed for many patients with a high prevalence of contraindicated therapies. More data is needed to fully characterize the epidemiological impact and appropriateness of interventions being applied. Although KRPCC records are a useful resource, these records are self reported data and do not fully capture the impact of snake envenomations on Kentucky residents.