Incidence of fatal snake bite in Australia: A coronial based retrospective study (2000–2016)

Highlights

• The rates of mortality from snakebite envenoming in Australia, while low, has remained similar for over 30 years in Australia.

• Collapse and cardiac arrest were commonly described in coronial reports where a diagnosis of snakebite was identified.

• Haemorrhagic, heavy lungs and petechial bleeding over heart and lungs is a common characteristic of snakebite envenoming found on autopsy.

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Introduction

It has been over 25 years since a national review of recorded deaths from snake bite has been conducted (Sutherland, 1992). Together with the distribution of animals (Cogger, 2011), national injury trends (Henley and Harrison, 2015, Bradley, 2008, Welton et al., 2017) and clinical signs and symptoms from selected hospital datasets (Meier and White, 2008, Churchman et al., 2010, Allen et al., 2012, Scop et al., 2009), the assigned cause of death and demographics from snake envenoming can inform and update snake bite management in Australia.

Australian health policies are based on national statistics and expert submissions that are pivotal to informing national health guidelines and supporting resource allocation and education. Snake bite is categorised as an unintentional injury within Australian government health frameworks, and as a rarely occurring injury, is merged with seven other injuries forming an ‘other unintentional injury’ group. This is one of nine unintentional injury groups collated nationally (Henley and Harrison, 2015). While snake bite in Australia is not considered a significant injury, with approximately 550 annual admissions to public hospitals (2.4 per 100,000) (Bradley, 2008, Welton et al., 2017) and an average of 2 deaths per year (0.13 per 100,000) (Welton et al., 2017), the risk of this injury can be life threatening.

Here we report all deaths from snake bite and their associated causes of death and demographics from 2000 to 2016. This information may be important in the management of other patients and can provide feedback for state and national injury prevention and education agendas.