Snakebite affects thousands of people in the United States each year and is responsible for significant morbidity and even mortality in some patients. Despite the large impact snakebite has on affected individuals, it is a relatively uncommon diagnosis, and many physicians have never treated a patient with snakebite. Medical toxicologists are unique among physician specialists in that they receive specialized training in the management of snakebite.
Current understanding of the pathophysiology of snake venom, factors that may influence morbidity and mortality after snakebite, and ideal management of patients suffering from snake envenomation is incomplete. Much of what is known derives from retrospective case series describing cohorts of patients with envenomation as well as case reports of unusual presentations following snakebite. Published clinical trials of rattlesnake antivenom have provided some prospective information regarding clinical effects of venom and response to treatment with antivenom, but also highlight the limitations in our ability to effectively treat patients and predict outcomes following snake envenomation.
ToxIC’s North American Snakebite Registry (NASBR) was established in 2013. It is a nationwide surveillance tool that prospectively gathers deidentified information from medical toxicologists providing bedside care for patients with envenomations. Between 2013 and 2023, 2,140 cases have been submitted to the registry from over 20 participating sites. Data collected includes details on the snakebite encounter such as snake genus and species, clinical effects of envenomation, diagnostic or laboratory tests, treatment, and any outpatient follow-up or readmissions post-discharge. The purpose of the Registry is to use the information gathered to decrease morbidity and mortality resulting from snakebite through the enhanced understanding of factors that affect clinical response to snake envenomation and response to various treatments.
2023
1. Basse J, Ruha AM, Baumgartner K, Mullins ME, Green S, Wax P, Brent J, Campleman S, Schwarz E; On behalf of the ToxIC Snakebite Study Group. Clinical Presentations, Treatments, and Outcomes of Non-native Snake Envenomations in the United States Reported in the North American Snakebite Registry. J Med Toxicol. 2023;19(1):16-25. View Publication
2. Brandehoff N, Dalton A, Daugherty C, Dart RC, Monte AA; On behalf of the ToxIC Snakebite Study Group. Total CroFab and Anavip Antivenom Vial Administration in US Rattlesnake Envenomations: 2019-2021. J Med Toxicol. 2023;19(3):248-254. View Publication
3. Greene S, Gilbert M, Wolk B, Campleman S, Michelle-Ruha M; On behalf of the ToxIC Snakebite Study Group. Geographic variation in the clinical features of Mohave rattlesnake (Crotalus scutulatus) envenomations reported to the North American Snakebite Registry. Toxicon X. 2023;21:100171. View Publication
4. Spyres M, Maker G, Aldy K, Meadors K, Christian M, Ruha M; On behalf of the ToxIC Snakebite Study Group. Compartment Syndrome after Crotalid Envenomation in the United States: A Review of the North American Snakebite Registry from 2013 to 2021. Wilderness Environ Med. 2023;34(3):322-327. View Publication
2022
1. Spyres MB, Padilla GK, Gerkin RD, Hoyte CO, Wold BJ, Ruha AM; On behalf of the ToxIC Snakebite Study Group. Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab’)2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry. Clin Toxicol (Phila). 2022;60(7):838-842. View Publication
2021
1. Greene S, Ruha AM, Campleman S, Brent J, Wax P; On behalf of Toxicology Investigator’s Consortium (ToxIC). Epidemiology, clinical features, and management of the Texas Coral Snake (Micrurus tener) envenomations reported to the North American Snakebite Registry. J Med Toxicol. 2021;17(1):51-56. View Publication
2020
1. Domanski K, Kleinschmidt KC, Greene S, Ruha AM, Berbata V, Onisko N, Campleman S, Brent J, Wax P; on behalf of the ToxIC North American Snakebite Registry Group. Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017. Clin Toxicol (Phila). 2020;58(3):178-182. View Publication
2. Levine M, Ruha A, Wolk B, Caravati M, Brent J, Campleman S, Wax P; on behalf of the ToxIC North American Snakebite Study Group. When it comes to snakebites, kids are little adults: A comparison of adults and children with rattlesnake bites. J Med Toxicol. 2020;16(4):444-451. View Publication
2018
1. Kleinschmidt K, Ruha AM, Campleman S, Brent J, Wax P. Acute adverse events associated with the administration of Crotalidae polyvalent immune Fab antivenom within the North American Snakebite Registry. Clin Toxicol (Phila). 2018;24:1-6. View Publication
2. Spyres MB, Ruha AM, Kleinschmidt K, Vohra R, Smith E, Padilla-Jones A. Epidemiology and clinical outcomes of snakebite in the elderly: A ToxIC database study. Clin Toxicol (Phila). 2018;56(2):108-112. View Publication
2017
1. Ruha AM, Kleinschmidt KC, Greene S, Spyres MB, Brent J, Wax P, Padilla-Jones A, Campleman S; ToxIC Snakebite Study Group. The epidemiology, clinical course, and management of snakebites in the North American Snakebite Registry. J Med Toxicol. 2017;13(4):309-320. View Publication
2016
1. Spyres MB, Ruha AM, Seifert S, Onisko N, Padilla-Jones A, Smith EA. Occupational snake bites: A prospective case series of patients reported to the ToxIC North American Snakebite Registry. J Med Toxicol. 2016;12(4):365-369. View Publication
2024
1. Spyres M, Glaser T, Culbreth R, Libelt E, Greene S, Ruha A; On behalf of the Toxicology Investigators Consortium (ToxIC) Snakebite Study Group. Analysis of Acute Hypersensitivity Reactions by Antivenom Type by Geographic Location in the North American Snake Bite Registry. J Med Toxicol 2024; 20:34-35. View Abstract.
2. Williams L, Spyres M, Greene S, Wolk B, Campleman S, Aldy K, Ruha M; On behalf of the Toxicology Investigators Consortium (ToxIC) Snakebite Study Group. Sidewinder (Crotalus cerastes) Bites Reported to the ToxIC North American Snakebite Registry (NASBR). J Med Toxicol 2022; 20:70-71. View Abstract.
2023
1. Dion C, Gerkin R, Hoyte C, Wolk B, Campleman S, Ruha AM, On behalf of the ToxIC Snakebite Study Group. Interspecies Differences in Rattlesnake Envenomations in the Western United States Reported to the North American Snakebite Registry. J Med Toxicol. 2023;19(2):63-168. View Abstract
2. Jurao AR, Spyres MB, Wolk MD, Campleman S, Ruha AM, On Behalf of the ToxIC Snakebite Study Group. Characteristics of Crotalid Venom-Induced Neurotoxicity in the North American Snakebite Registry (NASBR). J Med Toxicol. 2023;19(2):63-168. View Abstract
3. Ruha AM, Spyres MB, Culbreth R, Wolk B, Hoyte C, Campleman S, On Behalf of the ToxIC Snakebite Study Group. Systemic Toxicity after Rattlesnake Envenomation in Patients Using Angiotensin Converting Enzyme Inhibitors in the North American Snakebite Registry. J Med Toxicol. 2023;19(2):63-168. View Abstract
4. Ryan K, Spungen H, Tershera M, Greene S, Warpinski G, Aldy K, Ruha AM; On Behalf of the ToxIC North American Snakebite Study Group. The Circumstances Surrounding Snakebite in the United States: A Survey of Surreptitious Serpent-Person Skirmishes. Clin Toxicol (Phila). 2023;61:113. View Abstract
2022
1. Atti S, Ryan E, Rushton W, Beuhler M, Shaker K, Aldy K, Campleman S, Wax P, Brent J, Ruha M; On Behalf of the Toxicology Investigators Consortium (ToxIC) North American Snakebite Study Group. Snake Bites in Diabetic Patients: A Descriptive Analysis. J Med Tox. 2022;18:97. View Abstract
2. Atti S, Farah R, Beuhler M, Shaker K, Aldy K, Campleman S, Wax P, Brent J, Ruha AM; On behalf of the ToxIC North American Snakebite Study Group. A comparison of snakebite patients in those with and without diabetes. Clin Toxicol (Phila). 2022;60(S2):36. View Abstract
2021
1. Basse J, Greene S, Ruha AM, Baumgartner K, Mullins M, Wax P, Brent J, Campleman S, Schwarz E; On Behalf of the ToxIC Investigators Consortium (ToxIC). Clinical Presentations, Treatments, and Outcomes of Exotic Snake Envenomations in the United States. J Med Toxicol. 2021;17:100-101. View Abstract
2. Lavonas EJ, Dalton AM, Olson R, Rapp-Olsson M, Reynolds K, Ruha AM, Campleman S, Aldy K, Dart RC, On behalf of the North American Snakebite Study Group. Most Rattlesnake Envenomation Patients Receive Multiple Doses of Antivenom. Annals of Emergency Medicine; 2021; 78(4): S30-S31. View Abstract
3. Lavonas EJ, Rapp-Olsson M, Dalton AM, Reynolds AM, Dart RC; On Behalf of the ToxIC Investigators Consortium (ToxIC). Most Rattlesnake Envenomation Patients Receive Multiple Doses of Antivenom. Acad Emerg Med. 2021; 28 (Suppl. 1): S86. View Abstract
4. Pitotti C, Kaplan S, Ruha AM, Wolk B, Hoyte C; On behalf of the North American Snakebite Study Group. Characterization of F(ab’)2 and Fab crotalidae antivenom single and combination therapy 2018-2020: retrospective analysis of the North American Snakebite Registry. Clin Toxicol (Phila). 2021; 59(11):1038-1039. View Abstract
5. Spyres M, Makar G, Meadors K, Ruha AM;On behalf of the ToxIC North American Snakebite Study Group. Compartment syndrome and rattlesnake envenomation: a review of the NASBR subregistry 2013-2020. Clin Toxicol (Phila). 2021; 59(11):1123. View Abstract
2018
1. Ruha AM, Gerkin R, Wolk B, Caravati E, Brent J, Campleman S, Wax P, On Behalf of the ToxIC Investigators Consortium (ToxIC) North American Snake Bite Registry (NASBR). Association Between Initial Platelet Count and Antivenom Dose Following Rattlesnake Envenomation. J Med Toxic 2018,14:46. View Abstract
2017
1. Levine M, Ruha M, Vohra R, Wolk B, Spyres M, Brent J, Wax P, Campleman S, On Behalf of the Toxicology Investigators Consortium (ToxIC) NASBR. Comparison Of Pediatric Vs. Adult Rattlesnake Envenomations: The ToxIC Experience. J Med Toxic 2017, 13: 13. View Abstract
2. Ruha A, Kleinschmidt K, Greene S, Spyres M, Wax P, Brent J, Padilla-Jones A, Campleman S, On Behalf of the Toxicology Investigators Consortium NASBR. The Epidemiologic and Clinical Characteristics of Snakebites in the North American Snakebite Registry. J Med Toxic 2017, 13: 4-5. View Abstract
3. Kleinschmidt K, Ruha A, Wax P, Brent J, Campleman S, On Behalf of the Toxicology Investigators Consortium NASBR. Acute Adverse Events Associated With The Administration of FabAV Within The North American Snakebite Registry. J Med Toxicol. 2017;3:4. View Abstract
2016
1. Darracq MA, Vohra R, Ruha AM. Cutting to the Chase: Observations on Debridement in Crotalid Envenomation. ACMT ToxIC North American Snakebite Registry. J Med Toxicol. 2016 March, 12(1):35. View Abstract
2. Moore EC, Vohra V, Wolk B, Ruha AM. Snakebite Neurotoxicity: a Retrospective Review of Patients Reported to the ToxIC North American Snakebite Registry. J Med Toxicol. 2016 March, 12(1):19. View Abstract
2015
1. Onisko, NS, Kleinschmidt KC, Greene S, Bebarta V, Ruha AM, Padilla-Jones A. Characteristics of Acute Cottonmouth Envenomation from the ToxIC North American Snakebite Registry (NASBR). J Med Toxicol. 2015 March, 11;32-33. View Abstract
2. Ruha AM, Kang AM, Onisko NS, Greene S, Vohra R, Seifert SA, Smith E, Padilla-Jones A. Antibiotic Use in the Management of Snake Envenomation. J Med Toxicol. 2015 March, 11;36-37. View Abstract
3. Ruha AM, Spyres, MB, Kleinschmidt KC, Greene S, Vohra R, Smith E, Padilla-Jones A. Snakebite in the Elderly: A Retrospective Cohort of Patients Reported to the ToxIC North American Snakebite Registry. J Med Toxicol. 2015 March, 11;37. View Abstract
2014
1. Ruha AM, Levitan R, Kleinschmidt KC, Vohra R, Smith E, Brent J, Wax PM. The ToxIC North American Snakebite Registry. J Med Toxicol. 2014;10:91. View Abstract
