INCIDENCE OF RETAINED FOREIGN BODY FOLLOWING A SNAKE BITE Dabrowski KH, Rushton WF, Vakkalanka JP, King JD, Charlton NP

University of Virginia, Division of Medical Toxicology - Department of Emergency Medicine

• Snake bites are a common complaint of ED visitors. • In 2011, there were 6,630 snake bite cases reported to the

American Association of Poison Control Centers.1

• Review of the literature demonstrates only a few cases of a retained snake tooth or fang following a snake bite.2,3

• However, numerous reputable sources for health care providers continue to advocate for routine imaging:

• [Rule out] retained fangs/teeth in wounds (examine wounds closely; x-ray)4

• 1st tests to order: wound x-ray. Other tests to consider: CT/MRI5

• Radiographs of the bitten area are needed to exclude fracture or foreign body in [certain exotic snake bites]6

• A single poison center database serving a population of approximately three million was queried for all cases indicating a snake bite from January 2003 through June 2013.

• Results were then searched for the following key terms: ‘fang’, ‘tooth’,

‘teeth’, ‘x-ray’, ‘xray’, ‘xr’, and ‘x ray.’

• Each chart that had at least one key term was independently reviewed for the presence or absence of a foreign body.

Conclusion

Results

Methods

• 1,679 charts coded for a snake bite returned from the query.

• 11% (n=183) contained one of the aforementioned key terms.

• Review of these charts did not result in any cases with a retained foreign body.

• Snake bites are a common presenting problem in U.S. emergency departments.

• Our review found no instances of retained foreign body in snake bites occurring between 2003 and June 2013.

• Based on the data from this poison center, we propose that snake bites do not require routine imaging studies to evaluate for retained foreign bodies as this is an exceedingly rare occurrence.

Background

1. Bronstein AC, Spyker DA, Cantilena LR, Rumack BH, Dart RC. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol. 2012; 50(10): 911-1164. 2. Sheard RM, Smith GT. Penetrating eye injury following a snake attack. Eye. 2003; 17(2): 279-80. 3. Weed HG. Nonvenomous snakebite in Massachusetts: prophylactic antibiotics are unnecessary. Ann Emerg Med. 1993; 22(2): 220-4. 4. Norris R. Snake Venom Poisoning in the United States. Stanford University. Available at http://emed.stanford.edu/education/Didactics/snakebites.htm. Accessed March 5, 2014. 5. Vearrier D, Greenberg M. Snake Bites Diagnoztic Tests. Epocrates. Available at https://online.epocrates.com/noFrame/showPage.do?method=diseases&MonographId=945&ActiveSectionId=34. Accessed March 5, 2014 6. Flomenbaum N, et al. Goldfrank's Toxicologic Emergencies. Vol. 8. New York: McGraw-Hill; 2006.

References

1,679 charts indicating a snake

bite

183 cases (11%) contained at least

one key search term

0 cases of retained foreign body

confirmed