Epidemiology and clinical outcomes of snakebite in the elderly: a ToxIC database study^*

Abstract

Introduction: Epidemiologic studies of snakebites in the United States report typical victims to be young men. Little is known regarding other demographics including children and the elderly. The objective of this study was to describe the epidemiology and clinical manifestations of snake bite in elderly patients reported to the ToxIC (Toxicology Investigators Consortium) North American Snakebite Registry (NASBR)

Methods: This was a multicenter analysis of a prospectively collected cohort of patients with snakebite reported to the ToxIC NASBR between 1 January 2013 and 31 December 2015. Inclusion criterion was age >65. Variables collected included patient demographics, medical comorbidities, medications, date the case was reported to the registry, location of exposure, bite location, snake species, clinical manifestations, outcomes, and management.

Results: Of the 450 cases reported, 30 (6.7%) occurred in elderly patients, with an average age of 74 years. Rattlesnake envenomations were common (93.3%). The majority of patients were men (66.7%) and reported at least one medical comorbidity (83.3%). Most patients were on cardiac medications (60%) and use of antiplatelet or anticoagulant medications was common (33%). Hemotoxicity occurred in 30% of patients on initial presentation and 11.5% of patients on initial follow-up. No clinically significant early or late bleeding was observed.

Conclusions: Elderly patients with North American snake envenomation are likely to have co-morbidities and to take medications that may increase their risk for hemotoxicity, however risk of bleeding or other complications was not increased in this group.

Keywords:

• Snakebite
• elderly
• rattlesnake
• ToxIC
• risk factor

Acknowledgements

The authors express gratitude to the staff at the American College of Medical Toxicology (ACMT) for support of the North American Snakebite Registry (NASBR) within the ToxIC Registry project. We would also like to thank the members of the 2015 ToxIC Snakebite Study (TICSS) group: Anna Arroyo-Plascencia, Vikhyat S. Bebarta, Michael C. Beuhler, William Boroughf, Jeffrey Brent, Daniel Brooks, E. Martin Caravati, James D. Cao, Nathan Charlton, Steven Curry, Michael Darracq, William Dribben, Kimberlie Graeme, Spencer Greene, Benjamin Hatten, Kennon Heard, C William Heise, Janetta Iwanicki, Aaron Min Kang, William P Kerns II, Thomas Kibby, Joshua King, Ronald Kirschner, Kurt Kleinschmidt, Ken Kulig, Michael Levine, Rachel Levitan, Elizabeth Moore, Philip Moore, Michael Mullins, Eleanor Oakley, Ayrn O’Connor, Nancy Onisko, Angie Padilla-Jones, Tammy Phan, Frank LoVecchio, Anne-Michelle Ruha, Steven A. Seifert, Daniel J Sessions, Aaron Skolnik, Eric Smith, Meghan Spyres, An Tran, S. Eliza Halcomb, Evan S. Schwarz, Shawn M. Varney, Rais Vohra, Brandon J. Warrick, Sam G. Wang, Paul Wax, and Brian J. Wolk.

Disclosure statment

The authors have no conflicts of interest to declare.

Additional information

Funding

There was no direct funding for this project. BTG International sponsored an unrestricted grant to ACMT for the NASBR registry.