Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?
Summary of "Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?"
To determine which laboratory tests are first associated with severe envenoming after a snakebite, when (ie, how long after the bite) the test results become abnormal, and whether this can determine a safe observation period after suspected snakebite. DESIGN, PATIENTS AND
Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite. Severe envenoming was defined as venom-induced consumption coagulopathy (VICC), myotoxicity, neurotoxicity or thrombotic microangiopathy. MAIN OUTCOME
International normalised ratio (INR), activated partial thromboplastin time (aPTT), creatine kinase (CK) level, and neurological examination.
There were 240 patients with severe envenoming, 75 with minor envenoming and 163 non-envenomed patients. Of 206 patients with VICC, 178 had an INR > 1.2 (abnormal) on admission, and the remaining 28 had an INR > 1.2 within 12 hours of the bite. Of 33 patients with myotoxicity, a combination of CK > 250 U/L and an abnormal aPTT identified all but two cases by 12 hours; one of these two was identified within 12 hours by leukocytosis. Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min - 12 h). The combination of serial INR, aPTT and CK tests and repeated neurological examination identified 213 of 222 severe envenoming cases (96%) by 6 hours and 238 of 240 (99%) by 12 hours.
Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.
Emergency Department, Gold Coast Hospital, Gold Coast, QLD, Australia. email@example.com.
This article was published in the following journal.
Name: The Medical journal of Australia
Medical and Biotech [MESH] Definitions
Laboratory Proficiency Testing
Assessments aimed at determining agreement in diagnostic test results among laboratories. Identical survey samples are distributed to participating laboratories, with results stratified according to testing methodologies.
Logical Observation Identifiers Names And Codes
A vocabulary database of universal identifiers for laboratory and clinical test results. Its purpose is to facilitate the exchange and pooling of results for clinical care, outcomes management, and research. It is produced by the Regenstrief Institute. (LOINC and RELMA [Internet]. Indianapolis: The Regenstrief Institute; c1995-2001 [cited 2002 Apr 2]. Available from http://www.regenstrief.org/loinc)
Diagnostic Test Approval
The process of gaining approval by a government regulatory agency for DIAGNOSTIC REAGENTS AND TEST KITS. This includes any required preclinical or clinical testing, review, submission, and evaluation of the applications and test results, and post-marketing surveillance.
Leukocyte Adherence Inhibition Test
Test for cell-mediated antitumor immunity and related serum blocking factors based on the finding that leukocytes from cancer patients, but not from controls, when mixed in vitro with antigenic extracts of tumors of the same histological type, undergo a diminution in their normal adherence to glass surfaces. Sera from tumor-bearing patients block the LAI reaction of their own leukocytes or those of other patients with the same type of tumor.
Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing using automated information entry.
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