Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, USA.
BMC Emerg Med. 2011 Feb 3;11:2. doi: 10.1186/1471-227X-11-2.
Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.
A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.
A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.
Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.
响尾蛇（响尾蛇、棉口蛇、铜头蛇）的毒液会导致一种复杂的、潜在致命的疾病，每年会影响美国数千人。响尾蛇咬伤的治疗方法尚未标准化，实践中存在显著差异。
为了得出一个基于证据的统一治疗算法，召集了一个地理上多样化的专家小组。研究人员分析了现有的医学文献，并对现有数据库进行了针对性分析，以告知特定的临床决策。一名经过培训的外部协调员使用改良 Delphi 和结构化共识方法就最终治疗算法达成共识。
产生了一个统一的治疗算法，并得到了所有九位专家组成员的认可。该算法提供了关于临床和实验室观察、抗蛇毒血清的适应症和剂量、辅助治疗、稳定后的护理以及毒液和治疗引起的并发症的管理的指导。
响尾蛇咬伤的临床表现和理想治疗方法差异很大，可能导致严重的并发症。我们使用改良 Delphi 方法提供基于证据的治疗指南，试图减少护理中的差异，并可能改善临床结果。
