A chance to cut is not always a chance to cure- fasciotomy in the treatment of rattlesnake envenomation: A retrospective poison center study. (July 2015) - Darracq, Michael A.
Abstract: Background: Fasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed. Methods: A retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed. Results: One-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital. Conclusions: Fasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation. Highlights: Fasciotomies take place without pressure measurement and without repeat dosing of antivenom. Fasciotomy patients spent an additional 2 days in the hospital. Fasciotomy does not reduce need for or dose of antivenom in patients with rattlesnake envenomation. Fasciotomy was not associated with clear morbidity benefit.