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      Is Open Access

      The “T’s” of snakebite injury in the USA: fact or fiction?

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          Abstract

          Background

          Venomous snakebites can result in serious morbidity and mortality. In the USA, the “T’s of snakebites” (testosterone, teasing, touching, trucks, tattoos & toothless (poverTy), Texas, tequila, teenagers, and tanks) originate from anecdotes used to colloquially highlight venomous snakebite risk factors. We performed an epidemiologic assessment of venomous snakebites in the USA with the objective of evaluating the validity of the “T’s of snakebites” at a national level.

          Methods

          We performed a retrospective analysis of the National Emergency Department Sample. Data from January 1, 2016 to December 31, 2016 were obtained. All emergency department (ED) encounters corresponding to a venomous snakebite injury were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Primary outcomes were mortality and inpatient admission. Demographic, injury, and hospital characteristics were assessed. Data were analyzed according to survey methodology. Weighted values are reported.

          Results

          In 2016, 11 138 patients presented to an ED with a venomous snakebite. There were 4173 (37%) persons aged 18 to 44, and 7213 (65%) were male. Most snakebites were reported from the South (n=9079; 82%), although snakebites were reported from every region in the USA. Only 3792 (34%) snakebites occurred in rural counties. Persons in the lowest income quartile by zip code were the most heavily represented (n=4337; 39%). The most common site of injury was the distal upper extremity (n=4884; 44%). Multivariate analysis revealed that species of snake (OR=0.81; 95% CI 0.73 to 0.88) and older age (OR=1.42; 95% CI 1.08 to 1.87) were associated with hospital admission. There were <10 inpatient deaths identified, and no variables were predictive of death.

          Discussion

          Some of the “T’s of snakebites” may be valid colloquial predictors of the risk for venomous snakebites. Based on national data, common demographics of venomous snakebite victims include lower income, Caucasian, and adult men in the South who are bit on the upper extremity. Understanding common demographics of venomous snakebite victims can effectuate targeted public health prevention messaging.

          Level of evidence

          IV.

          Related collections

          Most cited references 34

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          2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report.

          This is the 33rd Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2015, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.52 [7.40, 13.6] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.
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            2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report.

            This is the 34th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2016, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.50 [7.33, 14.6] (median [25%, 75%]) min, facilitating a near real-time national exposure and information database and surveillance system.
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              Bites of venomous snakes.

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                Author and article information

                Journal
                Trauma Surg Acute Care Open
                Trauma Surg Acute Care Open
                tsaco
                tsaco
                Trauma Surgery & Acute Care Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2397-5776
                2019
                30 October 2019
                : 4
                : 1
                Affiliations
                [1 ]departmentGeneral Surgery , Stanford University , Stanford, California, USA
                [2 ]departmentDepartment of Surgery , Stanford University , Stanford, California, USA
                Author notes
                [Correspondence to ] Dr Joseph D Forrester, Department of Surgery, Stanford University, Stanford, CA 94305, USA; jdf1@ 123456stanford.edu
                Article
                tsaco-2019-000374
                10.1136/tsaco-2019-000374
                6887492
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

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                Categories
                Original Research
                1506
                Custom metadata
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                injury, trauma, animal bite, animal attack, snakebite, envenomation

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