Resource Utilization After Snakebite Severity Score Implementation into Treatment Algorithm of Crotaline Bite

Amanda L. Fowler, Darrel W. Hughes, Mark T. Muir, Elizabeth M. VanWert, Conrado D. Gamboa, John G. Myers

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background Crotaline envenomation clinical manifestations vary considerably among patients. Current recommendations for treatment with Crotalidae polyvalent immune Fab require assessment of envenomation control. Determining control of envenomation, particularly when patients are evaluated by different providers in separate clinical settings, can be difficult. Objective To determine if a difference in total vials of Crotalidae antivenin therapy exists between pre-protocol and post-Snakebite Severity Score (SSS) protocol. Methods Retrospective medical record review at an academic medical and regional Level I trauma center. Resource utilization in patients with a diagnosis of “snakebite” was compared between patients treated pre- and post-SSS protocol implementation. Results One hundred forty-six patients were included in the evaluation. One hundred twenty-seven (87.0%) patients received antivenin, n = 80 (90.9%) in the pre-protocol group and n = 47 (81.0%) in the post-protocol group. Median total number of antivenin vials per patient was lower in the post-protocol group than the pre-protocol group, 16 (10–24 interquartile range) vs. 12 (10–16 interquartile range), p = 0.006. This decreased utilization correlates to an approximate $13,200 savings per patient. Hospital and intensive care unit length of stay, opioid use, incidence of blood product transfusion, need for surgical intervention, or need for intubation were not different between groups. Conclusions A snakebite protocol with SSS utilization to guide antivenin administration results in significantly decreased antivenin therapy in snakebite patients without increase in other health care utilization.

Original languageEnglish (US)
Pages (from-to)854-861
Number of pages8
JournalJournal of Emergency Medicine
Issue number6
StatePublished - Dec 2017


  • antivenin
  • clinical pharmacy
  • envenomation
  • outcomes
  • pharmacoeconomics
  • snake bite

ASJC Scopus subject areas

  • Emergency Medicine


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