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J Med Toxicol. 2017 Dec;13(4):309-320. doi: 10.1007/s13181-017-0633-5. Epub 2017 Oct 3.

The Epidemiology, Clinical Course, and Management of Snakebites in the North American Snakebite Registry.

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Division of Medical Toxicology and Precision Medicine, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA.
Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Departments of Emergency Medicine and Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Department of Emergency Medicine, Division of Medical Toxicology, University of Southern California, Los Angeles, CA, USA.
University of Colorado, School of Medicine, Aurora, CO, USA.
American College of Medical Toxicology, Phoenix, AZ, USA.
Division of Medical Toxicology and Precision Medicine, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA.


The American College of Medical Toxicology established the North American Snakebite Registry (NASBR), a national database of detailed, prospectively collected information regarding snake envenomation in the United States, in 2013. This report describes the epidemiology, clinical course, and management of snakebites in the NASBR. All cases entered into the NASBR between January 1, 2013 and December 31, 2015 were identified. Descriptive statistics are used to report results. Fourteen sites in 10 states entered 450 snakebites. Native species comprised 99% of cases, almost all of which were pit viper bites. 56.3% were identified as rattlesnakes and 29.4% as copperheads. 69.3% were male and 28.2% were children age 12 and under. Fifty-four percent of bites were on the lower extremity. Twenty-seven percent of patients with lower extremity bites were not wearing shoes. Common tissue findings associated with envenomation were swelling, ecchymosis, and erythema. Systemic effects and hematologic toxicity were more common in rattlesnake than copperhead or cottonmouth envenomations. Crotalidae Polyvalent Immune Fab antivenom was given to 84% of patients. Twelve patients (4.3%) were re-admitted to the hospital after completion of treatment. Eight were re-treated with antivenom. The NASBR gathers detailed data on venomous snakebites across the US. In its initial years, useful information has already been gained. Data regarding footwear will inform public health interventions and education, and information regarding the clinical presentation may help physicians better anticipate effects and manage snakebite. As the number of cases in the NASBR grows, associations between patient-related factors and outcomes may be studied.


Antivenom; Envenomation; Snake; Snakebite

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