Welton Ronelle E, Liew Danny, Braitberg George
Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Toxicon. 2017 Jun 1;131:11-15. doi: 10.1016/j.toxicon.2017.03.008. Epub 2017 Mar 10.
It has been over 20 years since a national review of recorded deaths from snake envenoming. The present study aimed to provide an updated review of the epidemiology of deaths from snake bites in Australia.
Deaths were identified from January 2000 to December 2016 from the National Coronial Information System. Cases identified due to snakes were extracted with data on coronial findings, autopsy and police records.
Thirty five deaths (2.2 per year) were ascribed or antecedent to a snake bite. Sixteen cases were attributed to snake bite/envenoming as leading directly to death, with other direct causes of death being multiple organ failure (n = 3), intracerebral haemorrhage (n = 2), cerebral hypoxia or anoxia (n = 3), cardiac arrest (n = 1), complications of snake bite (n = 3) or brain stem death (n = 1). Four cases did not have a snake bite indicated in the case history, with an initial diagnosis of either hyperthermia, stroke, gastroenteritis and a horse accident. The median age was 46.5 years (range 1.5-70 years), and 74% were males (n = 25). The time from bite to death varied from 1 h to 19 days. Fifty four percent of bites occurred at the person's residence (n = 1), with 17 being in an urban environment.
Death from snake bite remains rare in Australia, and has maintained a steady rate for over 20 years. Usually considered a 'rural issue', and with varying recorded causes of death, a nationally co-ordinated effort to further review the national picture of envenoming in Australia can inform education and resource needs within state and local contexts.
距离上次对蛇咬伤致死病例进行全国性审查已有20多年。本研究旨在提供澳大利亚蛇咬伤致死流行病学的最新综述。
从国家死因信息系统中识别出2000年1月至2016年12月期间的死亡病例。提取因蛇咬伤导致的病例以及死因调查、尸检和警方记录等数据。
35例死亡（每年2.2例）归因于或先于蛇咬伤。16例病例被认定蛇咬伤/中毒直接导致死亡，其他直接死因包括多器官功能衰竭（n =3）、脑出血（n =2）、脑缺氧或无氧血症（n =3）、心脏骤停（n =1）、蛇咬伤并发症（n =3）或脑干死亡（n =1）。4例病例病史中未提及蛇咬伤，最初诊断分别为体温过高、中风、肠胃炎和马匹事故。中位年龄为46.5岁（范围1.5 - 70岁），74%为男性（n =25）。从咬伤到死亡的时间从1小时到19天不等。54%的咬伤发生在个人住所（n =1），其中17例发生在城市环境。
在澳大利亚，蛇咬伤致死仍然罕见，并且在20多年里保持稳定发生率。通常认为这是一个“农村问题”，且死因记录各不相同，因此开展全国性协调努力以进一步审视澳大利亚中毒情况全貌，可为州和地方层面的教育及资源需求提供参考依据。
