Original Article

Epidemiology of the Reported Severity of Cottonmouth (Agkistrodon piscivorus) Snakebite

Authors: Frank G. Walter, MD, Uwe Stolz, PhD, MPH, Robert N.E. French, MD, Peter B. Chase, MD, PhD, Jude McNally, RPh, Farshad Shirazi, MD, PhD

Abstract

Objective: The goal of this study was to analyze trends in the annual rates of reported medical outcomes of cottonmouth (Agkistrodon piscivorus) snakebites in the United States, published in the annual reports of the American Association of Poison Control Centers in the course of 29 years.

Methods: This was a retrospective analysis of medical outcomes for cottonmouth snakebite victims who developed fatal, major, moderate, minor, or no effects. The annual rates for these medical outcomes were calculated by dividing the annual number of patients in each outcome category by the total annual number of people reported as being bitten by cottonmouths. Negative binomial regression was used to examine trends in annual rates.

Results: From 1985 through 2011, after controlling for the availability of CroFab, the annual incidence rate of cottonmouth snakebites causing no effect decreased significantly by 7.3%/year (incidence rate ratio [IRR] 0.927, 95% confidence interval [CI] 0.885–0.970), the incidence rate of minor outcomes did not change significantly (IRR 0.989, CI 0.974–1.006), the incidence rate of moderate outcomes increased significantly by 2.3%/year (IRR 1.023, CI 1.004–1.042), and the incidence rate of major outcomes did not change significantly (IRR 0.987, CI 0.935–1.041). One fatality was reported in 2011.

Conclusions: Annual rates of cottonmouth snakebites producing no effects decreased significantly, those producing minor outcomes did not change significantly, those producing moderate outcomes increased significantly, and those producing major outcomes did not change significantly, from 1985 through 2011.

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References

1. Veltri JC, Litovitz TL. 1983 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1984;2:420-443.
 
2. Litovitz T, Veltri JC. 1984 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1985;3:423-450.
 
3. Litovitz TL, Normann SA, Veltri JC. 1985 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1986;4:427-458.
 
4. Litovitz TL, Martin TG, Schmitz B. 1986 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1987;5:405-445.
 
5. Litovitz TL, Schmitz BF, Matyunas N, et al. 1987 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1988;6:479-515.
 
6. Litovitz TL, Schmitz BF, Holm KC. 1988 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1989;7:495-544.
 
7. Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1990;8:394-442.
 
8. Litovitz TL, Bailey KM, Schmitz BF, et al. 1990 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1991;9:461-509.
 
9. Litovitz TL, Holm KC, Bailey KM, et al. 1991 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1992;10:452-505.
 
10. Litovitz TL, Holm KC, Clancy C, et al. 1992 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1993;11:494-555.
 
11. Litovitz TL, Clark LR, Soloway RA. 1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1994;12:546-584.
 
12. Litovitz TL, Felberg L, Soloway RA, et al. 1994 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1995;13:551-597.
 
13. Litovitz TL, Felberg L, White S, et al. 1995 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1996;14:487-537.
 
14. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1997;15:447-500.
 
15. Litovitz TL, Klein-Schwartz W, Dyer KS, et al. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1998;16:443-497.
 
16. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1999;17:435-487.
 
17. Litovitz TL, Klein-Schwartz W, White S, et al. 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2000;18:517-574.
 
18. Litovitz TL, Klein-Schwartz W, White S, et al. 2000 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2001;19:337-395.
 
19. Litovitz TL, Klein-Schwartz W, Rodgers GC, et al. 2001 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002;20:391-452.
 
20. Watson WA, Litovitz TL, Rodgers GC, et al. 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003;21:353-421.
 
21. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004;22:335-404.
 
22. Watson WA, Litovitz TL, Rodgers GC, et al. 2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005;23:589-666.
 
23. Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 annual report of the American Association of Poison Control Centers’ National Poisoning and Exposure Database. Clin Toxicol (Phil) 2006;44:803-932.
 
24. Bronstein AC, Spyker DA, Cantilena LR, et al. 2006 annual report of the American association of Poison Control Centers’ National Poison Data System (NPDS). Clin Toxicol (Phil) 2007;45:815-917.
 
25. Bronstein AC, Spyker DA, Cantilena LR, et al. 2007 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS). Clin Toxicol (Phil) 2008;46:927-1057.
 
26. Bronstein AC, Spyker DA, Cantilena LR, et al. 2008 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th annual report. Clin Toxicol (Phil) 2009;47: 911-1084.
 
27. Bronstein AC, Spyker DA, Cantilena LR, et al. 2009 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 27th annual report. Clin Toxicol (Phil) 2010;48: 979-1178.
 
28. Bronstein AC, Spyker DA, Cantilena LR, et al. 2010 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th annual report.Clin Toxicol (Phil)2011;49:910-941.
 
29. Bronstein AC, Spyker DA, Cantilena LR, et al. 2011 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th annual report.Clin Toxicol (Phil) 2012;50:911-1164.
 
30. Parrish HM, Donnell HD Jr. Bites by cottonmouths (Ankistrodon piscivorus) in the United States. South Med J 1967;60:429-434.
 
31. Crocker P, Zad O, Milling T, et al. Human cytokine response to Texas crotaline envenomation before and after antivenom administration. Am J Emerg Med 2010;28:871-879.
 
32. Lawrence WT, Giannopoulos A, Hansen A. Pit viper bites: rational management in locales in which copperheads and cottonmouths predominate. Ann Plast Surg 1996;36:276-285.
 
33. Seifert SA, Boyer LV, Benson BE, et al. AAPCC database characterization of native U.S. venomous snake exposures, 2001-2005.Clin Toxicol (Phil) 2009;47:327-335.
 
34. Campbell BT, Corsi JM, Boneti C, et al. Pediatric snakebites: lessons learned from 114 cases. J Pediatr Surg 2008;43:1338-1341.
 
35. Uetz P, Hallermann J. The reptile database: Agkistrodon piscivorus 2010. http://reptile-database.reptarium.cz/species.php?genus=Agkistrodon&species=piscivorus&search_param=%28%28taxon%3D%27Crotalinae%27%29%29. Accessed January 13, 2011.
 
36. Wozniak EJ, Wisser J, Schwartz M. Venomous adversaries: a reference to snake identification, field safety, and bite-victim first aid for disaster-response personnel deploying into the hurricane-prone regions of North America. Wilderness Environ Med 2006;17:246-266.
 
37. Spiller HA, Bosse GM, Ryan ML. Use of antivenom for snakebites reported to United States poison centers. Am J Emerg Med 2010;28:780-785.
 
38. Walter FG, Stolz U, Shirazi F, et al. Epidemiology of severe and fatal rattlesnake bites published in the American Association of Poison Control Centers’ Annual Reports. Clin Toxicol (Phil) 2009;47:663-669.
 
39. Walter FG, Stolz U, Shirazi F, et al. Temporal analyses of coral snakebite severity published in the American Association of Poison Control Centers’ Annual Reports from 1983 through 2007. Clin Toxicol 2010;48:72-78.
 
40. Walter FG, Stolz U, Shirazi F, et al. Epidemiology of the reported severity of copperhead (Agkistrodon contortrix) snakebite. South Med J 2012;105:313-320.
 
41. Institute of Medicine. Forging a Poison Prevention and Control System. Washington, DC, The National Academies Press, 2004.
 
42. Collins J. Commentary on ‘‘epidemiology of the reported severity of copperhead (Agkistrodon contortrix) snakebite.’’ South Med J 2012;105:321.