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

Abstract

BackgroundVenomous 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.MethodsWe 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.ResultsIn 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.DiscussionSome 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 evidenceIV.

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

“…Also, in accordance with previous studies, the typical patient was male, as the keeping of snakes seems to be predominantly a male hobby [5,20,21]. It was also interesting to note that 11% of the bite victims suffered from ongoing or past substance abuse, which has been found to be a risk factor for a bite [26], and 33% had a history of at least one previous bite. Most bites occurred during activities involving the terrarium (i.e., cleaning it, changing the water) or during feeding procedures, which is reflected by the fact that the hand was the primary site of the bites.…”

Epidemiology and Characteristics of North American Crotalid Bites Reported to the National Poison Data System 2006–2020

“…The predominance of males in both pediatric and adult populations is consistent with prior studies 6,7 . This study was not designed to evaluate other commonly held risk factors for snake bites such as alcohol use 15 …”

“…6,7 This study was not designed to evaluate other commonly held risk factors for snake bites such as alcohol use. 15 North American crotalid bites are typically associated with significant clinical effects and this was reflected in our study, with 70% of cases resulting in a moderate or major clinical outcome. Pediatric rattlesnake bites had the highest reported major outcomes, with a 7.7% rate.…”

Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers

“…Needs identified by US health providers—a unified standard of care, government antivenom regulation, insurance cost transparency—reflect a lack of national policy and infrastructure for SBE. The minimal literature on SBE as a public health problem in the US aligns with this finding ( Jaramillo et al, 2019 ). In contrast, health providers in BR highlighted the need to enforce existing infrastructure, such as the Ministry of Health clinical practice guideline.…”