AAPCC database characterization of native U.S. venomous snake exposures, 2001-2005.

BACKGROUND: Differences in victim demographics, clinical effects, managements, and outcomes among native viperid (rattlesnake, copperhead, and cottonmouth) and elapid (coral snake) species have not been systematically characterized. METHODS: The database of the American Association of Poison Control Centers from 2001 through 2005 was analyzed. RESULTS: Between 2001 and 2005, there were 23,676 human exposures (average = 4,735/year) to native venomous snakes in the United States reported to U.S. poison centers in all states except Hawaii: 98% were to viperid snakes and 2% to elapids. Overall, 77% of victims were male, 70% were adults >20 years, and 12% were aged less than 10 years. Sixty-five cases involved pregnant women, with rattlesnake bites resulting in moderate or greater effects in over 70%. The overall hospital admission rate was 53%. Outcomes were generally more severe with rattlesnake and copperhead envenomations and in children <6 years of age. The fatality rate of reported cases was 0.06%. CONCLUSIONS: Native U.S. venomous snakebite results in considerable morbidity and mortality. Rattlesnake and copperhead envenomations, and those in children <6 years of age, produce the most severe outcomes, but coral snakebites result in similar hospital admission rates.

Does age matter? Comparing case fatality rates for selected poisonings reported to U.S. poison centers.

BACKGROUND: As the elderly population continues to grow, the number of geriatric patients reported to poison centers continues to increase. We believe that older poisoned patients are at an increased risk of death compared to younger adult patients. The objective of this study was to compare the risk of death from selected poisoning between younger (<59) and older (>59) adults. METHODS: We included adult cases reported to U.S. poison centers between 1995 and 2002. To limit potential confounders, our analysis included single substance ingestions of theophylline, digoxin, benzodiazepines, tricyclic antidepressants, calcium channel antagonists, acetaminophen, and salicylate. We determined the case fatality rate for each poisoning for younger and older adults. We calculated crude odds ratios for each poison and then used logistic regression to adjust for covariates. RESULTS: Overall we found an increase in the relative rate of death for each poison (range 1.2 to 7.1). After adjustment, each 10-year increase in age was associated with a 36% increase in the odds ratio for death as an outcome. Our findings were limited by the use of poison center data, which does not include data on covariates that may be potential confounders.