PubTransformer

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PMID- 28764620
OWN - NLM
STAT- MEDLINE
DA  - 20170802
DCOM- 20170807
LR  - 20170807
IS  - 1326-5377 (Electronic)
IS  - 0025-729X (Linking)
VI  - 207
IP  - 3
DP  - 2017 Aug 07
TI  - The Australian Snakebite Project, 2005-2015 (ASP-20).
PG  - 119-125
AB  - OBJECTIVE: To describe the epidemiology, treatment and adverse events after
      snakebite in Australia. DESIGN: Prospective, multicentre study of data on
      patients with snakebites recruited to the Australian Snakebite Project
      (2005-2015) and data from the National Coronial Information System. Setting,
      participants: Patients presenting to Australian hospitals with suspected or
      confirmed snakebites from July 2005 to June 2015 and consenting to participation.
      MAIN OUTCOME MEASURES: Demographic data, circumstances of bites, clinical effects
      of envenoming, results of laboratory investigations and snake venom detection kit
      (SVDK) testing, antivenom treatment and adverse reactions, time to discharge,
      deaths. RESULTS: 1548 patients with suspected snakebites were enrolled, including
      835 envenomed patients (median, 87 per year), for 718 of which the snake type was
      definitively established, most frequently brown snakes (41%), tiger snakes (17%) 
      and red-bellied black snakes (16%). Clinical effects included venom-induced
      consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%);
      severe complications included cardiac arrest (25 cases; 2.9%) and major
      haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year),
      attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed
      out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of
      597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%)
      were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%)
      were false positives. 755 patients received antivenom, including 49 non-envenomed
      patients; 178 (24%), including ten non-envenomed patients, had systemic
      hypersensitivity reactions, of which 45 (6%) were severe (hypotension,
      hypoxaemia). Median total antivenom dose declined from four vials to one, but
      median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours).
      CONCLUSIONS: Snake envenoming is uncommon in Australia, but is often severe.
      SVDKs were unreliable for determining snake type. The median antivenom dose has
      declined without harming patients. Improved early diagnostic strategies are
      needed to reduce the frequently long delays before antivenom administration.
FAU - Johnston, Christopher I
AU  - Johnston CI
AD  - NSW Poisons Information Centre, Sydney Children's Hospitals Network, Sydney, NSW 
      [email protected]
FAU - Ryan, Nicole M
AU  - Ryan NM
AD  - University of Newcastle, Newcastle, NSW.
FAU - Page, Colin B
AU  - Page CB
AD  - Calvary Mater Newcastle, Newcastle, NSW.
FAU - Buckley, Nicholas A
AU  - Buckley NA
AD  - University of Sydney, Sydney, NSW.
FAU - Brown, Simon Ga
AU  - Brown SG
AD  - University of Western Australia, Perth, WA.
FAU - O'Leary, Margaret A
AU  - O'Leary MA
AD  - University of Newcastle, Newcastle, NSW.
FAU - Isbister, Geoffrey K
AU  - Isbister GK
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PL  - Australia
TA  - Med J Aust
JT  - The Medical journal of Australia
JID - 0400714
RN  - 0 (Antivenins)
RN  - 0 (Snake Venoms)
SB  - IM
MH  - Acute Kidney Injury/epidemiology
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Animals
MH  - Antivenins/*administration & dosage/adverse effects
MH  - Australia/epidemiology
MH  - Child
MH  - Child, Preschool
MH  - Disseminated Intravascular Coagulation/epidemiology
MH  - Female
MH  - Hemorrhage/epidemiology
MH  - Humans
MH  - Hypersensitivity/epidemiology
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Out-of-Hospital Cardiac Arrest/epidemiology
MH  - Prospective Studies
MH  - Snake Bites/*epidemiology/mortality/*therapy
MH  - Snake Venoms
MH  - Snakes/*classification
MH  - Young Adult
OTO - NOTNLM
OT  - Adverse drug reactions
OT  - Antivenoms
OT  - Envenomation
OT  - Rural health services
OT  - Snakebites
EDAT- 2017/08/03 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/08/03 06:00
PHST- 2017/01/31 [received]
PHST- 2017/06/08 [accepted]
AID - 10.5694/mja17.00094 [pii]
PST - ppublish
SO  - Med J Aust. 2017 Aug 7;207(3):119-125.