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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Notes/Citation Information

Published in BMC Emergency Medicine, v. 15, article 9, p. 1-21.

© 2015 Lavonas et al.; licensee BioMed Central.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

The full list of members for the Copperhead Snakebite Recovery Outcome Group:

BTG International, Inc. (West Conshohocken, PA): Karen Arcuri, Claire A. Daugherty, Anna Temu; Denver Health and Hospital Authority – Rocky Mountain Poison and Drug Center (Denver, CO): Victoria E. Anderson, Becki Bucher Bartelson, Michael S. Coulter, Stephanie M. Gillman, Erin M. Goodman, Vaishali Khatri, Eric J. Lavonas, Jason E. Lones, Elizabeth A. Spradley, Jun Sun; Duke University (Durham, NC): Charles J. Gerardo, Weiying G. Drake; Louisiana State University Health Sciences Center (Shreveport, LA): Thomas C. Arnold, Kimberley Hutchinson; St. Joseph Regional Health Center (Bryan, TX): Brandon J. Lewis, Debbie Lewis; Scott and White Memorial Hospital (Temple, TX): Tina C. Amlin, David L. Morgan; Texas Health(Fort Worth, TX): Cathy Dykes, William R. Witham; University of Kentucky (Lexington, KY): Rebecca C. Bowers, Joann Short; University of Mississippi Medical Center (Jackson, MI): Robert D. Cox; University of Virginia Health System (Charlottesville, VA): Lea H. Becker; Nathan P. Charlton; East Carolina University/Vidant Medical Center (Greenville, NC): Eric A. Toschlog, Frank R. Watkins; Virginia Commonwealth University (Richmond, VA): S. Rutherfoord Rose; Washington University (St. Louis, MO): Michael E. Mullins.

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Funding Information

This study was funded by BTG International, Inc, the manufacturer of FabAV. The coordinating center and each study site received research grant support for participation in this study.

In addition, this study was supported by NIH/NCATS Colorado CTSI Grant Number UL1 TR001082.