rss
Emerg Med J 22:399-400 doi:10.1136/emj.2004.022251
  • Short report

Snake antivenom research: the importance of case definition

  1. G K Isbister
  1. Correspondence to:
 G K Isbister
 Senior Research Fellow and Clinical Toxicologist, Tropical Toxinology Unit, Charles Darwin University, Darwin and Newcastle Mater Hospital, Newcastle, Australia; gsbiteferntree.com
  • Accepted 12 January 2005

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 resources needed to measure venom concentrations in envenomed patients.

RCTs of antivenom are difficult to undertake for a number of reasons. The clear efficacy in many …


Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Poll

Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?

Results

0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article