Data collection in clinical toxinology: Debunking myths and developing diagnostic algorithms

Clinical toxinology suffers from a long history of poor data collection. A 20-year review of MEDLINE illustrates the lack of randomized controlled trials and prospective studies in clinical toxinology. Mythology surrounds bites and stings, resulting from the general fear of many creatures such as spiders, which has not been disproved by appropriate well-designed studies. The current focus on necrotic arachnidism in many parts of the world is a good example. Previously, most studies have been retrospective, bites and stings have not been confirmed, and creatures have not been kept or have been incorrectly identified. Prospective observational studies of confirmed bites with correct identification of the creature are required in clinical toxinology. This requires a collaboration between those who can correctly identify the animals (biologists/taxonomists) and those involved in the clinical management (poison information services, emergency departments, and toxicology services). Prospective collection of data pertaining to the circumstances and effects of the bites is essential. Routine follow-up is required to identify delayed effects and the duration of immediate effects. Analysis of databases created from prospective studies will not only answer questions about the effects of different species, but will ultimately allow the development of evidence-based methods to identify animals based on the circumstances and effects of bites, rather than requiring formal identification of the culprit.