Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.Envenomation by pit vipers (family Viperidae, subfamily Crotalinae, genera Crotalus, Agkistrodon, and Sistrurus) is a dynamic and potentially serious medical condition. Approximately 9,000 patients are treated for snakebite and 5 die in the United States (US) each year [1,2]. The use of antivenom is increasing over time. Forty-four percent of patients whose cases were reported to US poison centers in 2007 were treated with antivenom, a significant increase from 30% in 2000 [3]. The proportion of patients receiving antivenom varies more than 5-fold between states. Poison center data suggest a case-fatality rate among rattlesnake victims of approximately 1 death per 736 patients [4].The clinical manifestations of crotaline envenomation vary considerably based on a complex interplay between the victim and the venom exposure. Some critical manifestations, such as airway involvement and anaphylaxis to venom, are so uncommon that few clinicians gain experience manag