The Australian Snakebite Project, 2005–2015 (ASP-20)

Christopher I Johnston, Nicole M Ryan, Colin B Page, Nicholas A Buckley, Simon GA Brown, Margaret A O'Leary and Geoffrey K Isbister
Med J Aust 2017; 207 (3): 119-125. || doi: 10.5694/mja17.00094


Objective: To describe the epidemiology, treatment and adverse events after snakebite in Australia.

Design: Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005–2015) and data from the National Coronial Information System.

Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation.

Main outcome measures: Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths.

Results: 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7–6.3 hours).

Conclusions: Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.

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  • Christopher I Johnston1,2
  • Nicole M Ryan2
  • Colin B Page3
  • Nicholas A Buckley4
  • Simon GA Brown5,6
  • Margaret A O'Leary2
  • Geoffrey K Isbister2,3

  • 1 NSW Poisons Information Centre, Sydney Children's Hospitals Network, Sydney, NSW
  • 2 University of Newcastle, Newcastle, NSW
  • 3 Calvary Mater Newcastle, Newcastle, NSW
  • 4 University of Sydney, Sydney, NSW
  • 5 University of Western Australia, Perth, WA
  • 6 Centre for Clinical Research in Emergency Medicine (CCREM), Harry Perkins Institute of Medical Research, Perth, WA



Geoffrey Isbister is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship (1061041). Nicole Ryan is supported by an NHMRC Early Career Fellowship. Colin Page is funded by a Queensland Emergency Medicine Research Foundation Fellowship. The study described in this article is funded by an NHMRC Centre for Research Excellence Grant (1110343). We acknowledge the help of numerous critical care nurses and medical staff who assisted in recruiting patients to the study, and the local investigators at hospitals around Australia.

Competing interests:

Christopher Johnston is employed by Boehringer Ingelheim; this research was independent of his employment by Boehringer Ingelheim.

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