ANTIVENOM USE OR OBSERVATION FOR PATIENTS WITH COPPERHEAD SNAKE ENVENOMATION? Kelsey Baab1, Fatima Ramirez-Cueva, DO2, Adam Larsen, DO3, Elise Knowlton, MS3, Robin Rainey Kiehl1, Amy Hendrix, MA3, Michelle Condren, PharmD3, Megan Woslager, MD3 1OU School of Community Medicine, 2Pediatric Emergency Medicine, Augusta University, 3Pediatrics, OU-Tulsa Introduction: Crotaline snake envenomation is a potentially serious medical condition affecting thousands of Americans each year. Snakes in the subfamily Crotalinae include, but are not limited to, copperheads, rattlesnakes, and cottonmouths. Variation in treating crotaline snakebites exists among physicians in the United States. In particular, managing copperhead envenomation is hypothesized to require minimal intervention, rarely requiring antivenom use and, even rarer, surgical intervention. This study assessed FabAV antivenom use and treatment outcomes for copperhead-envenomated patients in northeastern Oklahoma. Methods: A retrospective cross-sectional review examined electronic medical records (EMR) of patients with crotaline snakebites from July 1, 2014 to August 31, 2019 at St. Francis Hospital in Tulsa, Oklahoma. Patient demographics, snake species, clinical presentation, comorbidities (psychiatric, cardiovascular, pulmonary and hematologic/oncologic), lab results, and treatment types (FabAV or observation) were collected. Associations between patient variables and treatment were evaluated using the χ2, Median tests, and binary logistic regression. Results: Of 256 patients meeting inclusion criteria, 139 were envenomated by a copperhead. Compared to patients under observation (no antivenom, n=42), those treated with antivenom (n=97) were more likely to have ICU stays (χ2(1)=29.5, p<0.001). Few patients under observation experienced complications requiring intervention (n=3, 7%) or ICU stays (n=2, 5%). For FabAV-treated patients, 17% experienced complications (n=16) and the majority had an ICU stay (n=54, 56%). Comparing the antivenom administered vs. observation cohorts, there were no statistically significant differences in the proportion of patients who were hemotoxic (χ2(1)=0.91, p=0.34), or in the number of systemic symptoms (χ2(1)=0.78, p=0.38). Progression of venom effects across major joints (p=0.001) and number of patient comorbidities (p<0.05) were significantly associated with FabAV treatment in a binary logistic regression model. Discussion: For those patients with a copperhead envenomation, treatment by observation had favorable patient outcomes, including reduced chance of an ICU stay and reduced overall length of hospital stay. Hospital policy of administering antivenom in the ICU for adult patients may contribute to the association between ICU stay and antivenom treatment. Kelsey Baab Medical Student 4502 E. 41st Street | Tulsa, OK 74135 | 918.770.5435 cell | OU-Tulsa<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ou.edu_tulsa&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=WCbcQvd9udkhZXzGsUHoAo57nTdgQfA2PibILLcJ0MU&m=vGqkn2zvR8qH_WGAU6Jmo3d_zLw49HFzIlR1-eWR1Zo&s=ZA3gAsKI0oBtyI8JQ5EMkay0noUTdyeSBECoMNvP_ks&e=> [X]