© 2005 BMJ Publishing Group Ltd, and British Association for Accident and Emergency Medicine
COMMENTARY
Snake antivenom research: the importance of case definition
Correspondence to:
Correspondence to:
G K Isbister
Senior Research Fellow and Clinical Toxicologist, Tropical Toxinology Unit, Charles Darwin University, Darwin and Newcastle Mater Hospital, Newcastle, Australia; gsbite@ferntree.com
Accepted 12 January 2005
| The first 150 words of the full text of this article appear below. |
Snake envenoming is a major public health issue in the rural tropics, with large numbers of envenomings and deaths.1,2 However, there continues to be limited evidence on the clinical features, epidemiology, and treatment of these patients.1,2 In some parts of the world, there is a continuing shortage of antivenom.3 Agarwal et al4 attempt to answer a pertinent clinical question in their region. The study aims to justify a reduced dose of antivenom (thus reducing cost of treatment) in their hospital and surrounding regions. However, while the study provides useful insight into the issues of snakebite management in the tropics, there are a number of problems with the design, and the study cannot be generalized to other parts of the world. The appropriate design for the study would be a randomised, controlled trial (RCT), but these are not often undertaken because of the difficulties with RCT in this setting and the
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