How is the snakebite severity score (SSS) used in the evaluation of snakebites?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Many hospitals rely on the snakebite severity score (SSS) to make treatment decisions. This research tool considers the local findings as well as the following five body systems that may be impacted by an envenomation:

  • Gastrointestinal system
  • Pulmonary system
  • Cardiovascular system
  • Central nervous system
  • Local wound
  • Hematologic system

Scores range from 0 (normal) to a maximum score of 23. Typically, antivenom is withheld for scores less than 5. However, the SSS frequently results in undertreatment. An envenomation causing swelling and ecchymosis beyond an entire extremity, but without systemic effects or laboratory abnormalities, would produce a score of 4 and would not be treated with antivenom, even though this would be considered a severe envenomation by more accepted standards.

Important to note: The SSS was not intended to guide patient care and has not been validated for clinical decision making. Its use should be restricted to research. [42]

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