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FabAV antivenin use after copperhead snakebite: clinically indicated or knee-jerk reaction?

Overview of attention for article published in Journal of Venomous Animals and Toxins including Tropical Diseases, January 2016
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  • Above-average Attention Score compared to outputs of the same age (61st percentile)
  • Good Attention Score compared to outputs of the same age and source (67th percentile)

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3 tweeters
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1 Facebook page
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1 Redditor

Citations

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7 Dimensions

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21 Mendeley
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Title
FabAV antivenin use after copperhead snakebite: clinically indicated or knee-jerk reaction?
Published in
Journal of Venomous Animals and Toxins including Tropical Diseases, January 2016
DOI 10.1186/s40409-016-0056-9
Pubmed ID
Authors

Stephen C. Gale, Jo Ann Peters, LaDonna Allen, Robert Creath, Viktor Y. Dombrovskiy

Abstract

Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) antivenin is commonly recommended after pit viper snakebites. Because copperhead envenomations are usually self-limited, some physicians are reluctant to use this costly treatment routinely, while others follow a more liberal approach. We hypothesized that, in practice, only patients with evidence of significant (moderate or severe) copperhead envenomation [those with snakebite severity score (SSS) > 3] receive FabAV and examined a large cohort to determine the relationship between clinical findings and FabAV administration. All data from patients evaluated for copperhead snakebite at a rural tertiary referral center from 5/2002 to 10/2013 were compiled. Demographics, transfer status, antivenin use, and clinical findings were collected; SSS was calculated. The relationships among FabAV use, clinical findings, and SSS were analyzed using t-test, chi-square, and Pearson's coefficient (p < 0.05 was significant). During the study period, 318 patients were treated for copperhead snakebite; 44 (13.8 %) received antivenin. Median dose was four vials (range: 1-10; IQR: 4,6). There were no deaths. Most patients receiving FabAV (63.6 %) were admitted. With regard to demographics and symptoms, only the degree of swelling (moderate vs. none/mild; p < 0.01) and bite location (hand/arm vs. leg: p < 0.0001) were associated with FabAV use. A SSS > 3, indicating moderate or severe envenomation, was only very weakly correlated with antivenin use (r = 0.217; p < 0.0001). The majority of patients with SSS > 3 (65.8 %) did not receive antivenin while most patients who did receive antivenin (70.5 %) had SSS ≤ 3 (indicating mild envenomation). Considerable variation occurs in antivenin administration after copperhead snakebite. Use of FabAV appears poorly correlated with patients' symptoms. This practice may expose patients to the risks of antivenin and increasing costs of medical care without improving outcomes. Guidelines used for treating other pit viper strikes, such as rattlesnake or cottonmouth snakebite may be too liberal for copperhead envenomations. Our data suggests that most patients with mild or moderate envenomation appear to do well independent of FabAV use. We suggest, for patients with copperhead snakebite, that consideration be given to withholding FabAV for those without clinical evidence of severe envenomation until prospective randomized data are available.

Twitter Demographics

The data shown below were collected from the profiles of 3 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 21 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 21 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 6 29%
Student > Doctoral Student 2 10%
Professor > Associate Professor 2 10%
Student > Bachelor 2 10%
Student > Ph. D. Student 2 10%
Other 4 19%
Unknown 3 14%
Readers by discipline Count As %
Medicine and Dentistry 8 38%
Agricultural and Biological Sciences 3 14%
Nursing and Health Professions 2 10%
Pharmacology, Toxicology and Pharmaceutical Science 2 10%
Veterinary Science and Veterinary Medicine 1 5%
Other 2 10%
Unknown 3 14%

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 January 2016.
All research outputs
#6,749,048
of 12,537,534 outputs
Outputs from Journal of Venomous Animals and Toxins including Tropical Diseases
#95
of 321 outputs
Outputs of similar age
#133,029
of 353,370 outputs
Outputs of similar age from Journal of Venomous Animals and Toxins including Tropical Diseases
#14
of 43 outputs
Altmetric has tracked 12,537,534 research outputs across all sources so far. This one is in the 45th percentile – i.e., 45% of other outputs scored the same or lower than it.
So far Altmetric has tracked 321 research outputs from this source. They receive a mean Attention Score of 3.4. This one has gotten more attention than average, scoring higher than 69% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 353,370 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 61% of its contemporaries.
We're also able to compare this research output to 43 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 67% of its contemporaries.