Outcomes of Copperhead Snake Envenomation Managed in a Clinical Decision Unit.

Objectives: Copperhead envenomations are the most common snakebite in the United States, and the majority are categorized as mild-moderate severity. The need for prolonged observation to monitor for signs of envenomation supports observation in a clinical decision unit (CDU). To our knowledge, no articles to date have reported on the clinical outcomes of patients managed in a snakebite CDU protocol.

Methods: We performed a five-year structured, retrospective cohort study of adult patients managed in a single-center CDU, compared to a 10-year period of historical cohort managed inpatient at the same institution. Several clinical parameters were abstracted for comparison. The primary outcome was effective management in CDU observation as measured by length of stay (LOS), disposition, and documented return for care within the hospital system. Secondary outcomes were management comparisons between groups, as measured by LOS, frequency of antivenom use and vials administered, and surgical interventions.

Results: The two cohorts included 59 patients on CDU observation protocol compared to 36 patients as historical inpatient management. Fifty-four patients (92%) were discharged from observation. Five patients converted to inpatient admission, mostly secondary to uncontrolled pain. After discharge, six patients in the CDU cohort (10.2%) returned for care within the network for wound checks and/or concern for extremity swelling; all were discharged. Compared to the inpatient cohort, patients managed in CDU observation had shorter LOS, less antivenom administered, and fewer surgical interventions.

Conclusion: Copperhead snakebites can be managed effectively in clinical decision unit observation. The majority of patients were discharged from observation with few return visits. Few patients required admission; those who did were secondary to pain control issues. Anticipated gains of CDU observation are shortened length of stay and lower resource utilization.