After the bite: evaluating a specialized clinic for follow-up care for snake envenomation.

Introduction: Pit viper envenomation causes tissue damage that can persist for weeks to months despite antivenom. Many patients do not receive post-discharge care beyond testing for late coagulopathy and primary care follow-up. The aim of this report is to describe a snake envenomation patient cohort, complications, and management strategies after three years of operation of a specialized outpatient clinic offering post-discharge evaluation and wound care therapy.

Methods: This was an observational study of patients treated in a newly established snakebite follow-up clinic from June 1, 2021 to November 30, 2023. Patient demographics, snake species, and hospital course were abstracted from poison center records. Persistent symptoms upon clinic evaluation were recorded as well as the therapies prescribed by the clinic wound care physicians.

Results: Of the 465 snake envenomations reported to the state poison center, 52 patients presented to the clinic. The median patient age was 29 years (range 5-88 years), and the majority (65.4%) were male. Antivenom was given during hospitalization in 92.3% of cases. Agkistrodon spp. envenomations (including Agkistrodon contortrix and Agkistrodon piscivorus) were most common (n = 33) with a smaller number of Crotalus horridus (n = 7) and 12 unidentified pit viper envenomations. Persistent edema (61.5%) and bullae (38.5%) were common at follow-up. Interventions provided included compression (38.5%), physical therapy referral (32.7%), tissue debridement (9.6%), and antibiotics (5.8%). Rates of edema and bullae were numerically higher in patients envenomated by Agkistrodon spp. compared to those envenomated by Crotalus horridus.

Discussion: In this primarily Agkistrodon spp.-envenomated cohort, persistent edema, wounds, and functional limitations were common in the post-discharge period. Our outpatient snake envenomation clinic leveraged the expertise of wound care physicians and the public health reach of the state poison center to address the significant morbidity seen on follow-up and provide interventions to facilitate recovery.

Conclusion: This snake envenomation wound care clinic addressed a neglected aspect of pit viper envenomation by providing post-discharge management of enduring tissue damage and other complications.