First step in assessment of VipGrade^®, a computerized clinical decision system to assess Vipera envenomation grading: a single-center interrater reliability study

Abstract

Methods

We conducted a retrospective review of Vipera spp. snakebite cases registered by the PCC of Bordeaux, France, between January 1, 2018, and December 31, 2020, evaluating the agreement between VipGrade^® assessments, toxicologists’ assessments, and current guidelines.

Results

133 patients with Vipera aspis snakebites were included. There was 100% agreement in severity grading by PCC guidelines and VipGrade^®. However, grading by toxicologists and VipGrade^® diverged in 19 cases (85% agreement; κ = 0.80; 95% CI: 0.71 to 0.87).

Conclusions

The VipGrade^® tool’s grading reflects current PCC guidelines, which are authoritative in France, and may allow for a more rapid and standardized determination of management and follow-up of viper-bitten patients. It should be noted, however, that the more complex and dynamic aspects of management are not included in VipGrade^®. Its purpose is to supplement, not replace, the advice of the PCC’s clinical toxicologists, and this advice should be sought whenever a viper bite is encountered in clinical practice.

Keywords:

• European viper
• snakebites
• envenomations
• antivenoms

Aknowledgements

The authors thank the French Clinical Toxicologists’ Society for its collaboration in the development of the tool.

Author contributions

DB, AC and ML designed the study. DB and AC collected the data. DB and PC analyzed the data. DB prepared the first draft of the manuscript. All authors commented on the following versions, and read and approved the final version. All authors declare they meet International Committee of Medical Journal Editors authorship criteria.

Disclosure statement

No potential conflict of interest was reported by the authors. The authors are the only ones responsible for the content and the writing of this article. DB developed Vipgrade^® in collaboration with PC and the French Society of Clinical Toxicology without sponsor entity. AC, CP and ML tested the tool, proposed evolution to improve it and allowed the validation of the tool.