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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2015

Open Access 01-12-2015 | Research article

Prospective study of recovery from copperhead snake envenomation: an observational study

Authors: Eric J Lavonas, Charles J Gerardo, for the Copperhead Snakebite Recovery Outcome Group

Published in: BMC Emergency Medicine | Issue 1/2015

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Abstract

Background

Although much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.

Methods

This is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale (PSFS), Work Productivity and Ability Impairment: Special Health Problem (WPAI: SHP), Patients’ Global Impression of Change (PGIC), Patient’s Global Assessment of Recovery (PGAR), and SF-36 instruments, obtained numeric pain rating scales, and measured grip strength, walking speed, and swelling prior to hospital discharge and 3, 7, 14, 21, and 28 days after envenomation.

Results

20 subjects were enrolled; none were lost to follow-up. Most (80%) had moderate severity swelling, and most (75%) received antivenom. Across the broad range of measures, abnormalities of pain, swelling, impairments of physical and role function, and quality of life persisted for 7–14 days in most subjects. Validated self-reported outcome measures, such as the DASH, LEFS, PSFS, PGIC, SF-36, and the daily activities impairment portion of the WPAI: SHP were more responsive than measurements of swelling or walking speed. Data quality issues limited the utility of the work impairment portion of the WPAI: SHP. Residual signs, symptoms, and impairment in some subjects lasted through the 28-day study period. The study design precluded any assessment of the effectiveness of antivenom.

Conclusions

Signs, symptoms, impaired function, and decreased quality of life typically last 7 – 14 days after copperhead envenomation. Several tools appear responsive and useful in studying recovery from pit viper envenomation.

Trial registration

ClinicalTrials.gov NCT01651299
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Metadata
Title
Prospective study of recovery from copperhead snake envenomation: an observational study
Authors
Eric J Lavonas
Charles J Gerardo
for the Copperhead Snakebite Recovery Outcome Group
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2015
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-015-0033-6

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