Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake‐envenomated Patients

Background Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this stu...

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Bibliographic Details
Published in:Academic emergency medicine 2018-08, Vol.25 (8), p.921-926
Main Authors: Levine, Michael, Offerman, Steve, Vohra, Rais, Wolk, Brian, LaPoint, Jeff, Quan, Dan, Spyres, Meghan, LoVecchio, Frank, Thomas, Stephen H., Bird, Steven B.
Format: Article
Language:English
Subjects:
Adult
Animals
California
Clinical outcomes
Crotalus
Emergency medical care
Female
Health care delivery
Hospitalization
Humans
Length of Stay - statistics & numerical data
Male
Medical personnel
Middle Aged
Patient Readmission
Quantitative analysis
Retrospective Studies
Snake bites
Snake Bites - therapy
Toxicology
United States
Venom
Young Adult
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Summary:Background Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this study was to evaluate the impact of a medical toxicology service (MTS) on the length of stay (LOS) of such patients. Methods The authors conducted a retrospective study at six centers in California. Patients were included if they were admitted in the 2 years before the establishment of a MTS (pre‐MTS) or in the 2 years after the creation of a MTS (post‐MTS). Results A total of 300 subjects were included (169 pre‐MTS, 131 post MTS). Baseline characteristics between the pre‐MTS and post‐MTS groups were very similar. The creation of a MTS was associated with a significant reduction in the mean (95% confidence interval) LOS (69.5 [59.1–79.9] hours vs. 48.1 [41.4–54.8] hours). This reduced LOS was not associated with any statistically significant change in readmission rates. Conclusion Rattlesnake bite patients treated by a medical toxicologist have a significantly reduced LOS compared to those without direct involvement of a medical toxicologist.
ISSN:1069-6563
1553-2712
DOI:10.1111/acem.13401