The Epidemiology, Clinical Course, and Management
of Snakebites in the North American Snakebite Registry
Kurt C. Kleinschmidt
Meghan B. Spyres
On Behalf of
the ToxIC Snakebite Study Group
Received: 27 July 2017 /Revised: 20 September 2017 /Accepted: 21 September 2017 /Published online: 3 October 2017
American College of Medical Toxicology 2017
Abstract The American College of Medical Toxicology
established the North American Snakebite Registry
(NASBR), a national database of detailed, prospectively col-
lected information regarding snake envenomation in the
United States, in 2013. This report describes the epidemiolo-
gy, 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 antiven-
om 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 educa-
tion, 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.
The data in this manuscript were presented at the American College of
Medical Toxicology’s Annual Scientific Meeting in San Juan, Puerto
Rico. April 2017.
* Anne-Michelle Ruha
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,
University of Colorado, School of Medicine, Aurora, CO, USA
American College of Medical Toxicology, Phoenix, AZ, USA
J. Med. Toxicol. (2017) 13:309–320