Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

INCIDENCE OF PAIN IN YOUTH SOFTBALL PITCHERS AND POSITIONAL PLAYERS

Nicole M. Bordelon1, Peyton Gober1, Jessica Talmage2, Kyle Wasserberger1, Anthony Fava1, Kate Everhart1, Jeff Dugas3, Gretchen Oliver, FACSM1. 1Auburn University, Auburn, AL. 2Northern State University, Aberdeen, SD. 3Andrews Sports Medicine Institute, Birmingham, AL. BACKGROUND: The rise in fastpitch softball participation across the United States is associated with increased injury rates. Pitchers are 2.6 times more likely to sustain an injury than positional players; therefore, the purpose of this study was to compare the incidence of pain between youth softball pitchers and positional players. METHODS: 33 youth (\u3c18yrs) fastpitch softball pitchers (age: 13.7 ± 2.0yrs, height: 163.8 ± 8.2cm, weight: 63.7 ± 16.0kg) and 56 positional players (age: 14.9 ± 2.5yrs, height: 159.8 ± 17.6cm, weight: 63.1 ± 14.8kg) completed an online Qualtrics® survey during the 2021 season. The presence of pain was determined by answering “yes” to the question, “Do you currently experience any pain/discomfort?”. Those who answered “no” were considered “pain free”. A Chi-Square Test of Independence was used to analyze the association between position (pitcher or positional) and incidence of pain. Statistical significance was set a priori to p\u3c0.05. Descriptive analyses were performed to examine pain location, intensity [0(least)-10(most pain) scale], and the frequency of those who continue to play with the onset of pain. RESULTS: 30% (n = 10) and 38% (n = 21) of pitchers and positional players reported experiencing pain, respectively. However, the Chi-Square Test of Independence revealed no statistically significant association between position and pain incidence (χ (1) = .474, p=.491). The most frequently reported pain locations were the shoulder (40%) and elbow (30%) for pitchers and the shoulder (62%) and knee (33%) for positional players. The average pain intensity was 5.2 and 5.0 for pitchers and positional players, respectively. The percentage of pitchers and positional players who played through their experienced pain during practice or competition was 70% and 82%, respectively. CONCLUSIONS: Pitchers did not exhibit a higher incidence of pain than positional players; however, it is important to note the high incidence of pain in both pitchers (30%) and positional players (38%). Future research should identify upper extremity pain and injury risk factors in pitchers and positional players since the shoulder and elbow were two of the most frequently reported pain locations. Athlete monitoring and injury prevention strategies should be enhanced to reduce the rates of athletes playing with pain during practice and competition