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The ToxIC North American Snakebite Registry


Snakebite affects thousands of people in the United States each year and is responsible for significant morbidity and even mortality in some victims. 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 2020, 1,417 cases have been submitted to the registry from over 18 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.

North American Snakebite Registry Contributing Sites



Authorship Guidelines for the North American Snakebite Registry

All medical toxicologists who contribute cases to the registry may be listed as members of the ToxIC Snakebite Study (TICSS) group, which will be credited in all publications stemming from the registry. Individuals with significant administrative involvement in the development and maintenance of the registry will also be considered part of the TICSS group and are eligible for individual authorship.

Individually listed authors will include 1-2 investigators from the site contributing the most cases to the registry, as well as a single investigator from the next two sites with the highest case contribution.

The lead author for any given publication will be a site investigator who has contributed at least five snakebite cases to the registry and who has submitted and received approval for a research proposal to the ACMT Research Committee.

All authors must meet the following requirements: 1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published.

Principal Investigator Contact Information

Anne-Michelle Ruha, MD

Banner University Medical Center Phoenix