Outcomes after massive honeybee envenomation in patients with comorbid conditions during hospital admission: a retrospective review
AffiliationThe University of Arizona College of Medicine – Phoenix
MeSH SubjectsCommunity Preventative Medicine
MetadataShow full item record
PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractThis study’s aim was to discover the outcomes associated with massive honeybee envenomation. Additionally, we wanted to observe what trends might be seen with regard to outcomes in patients with comorbidities and those without. Honeybees belong to the insect family of Hymenoptera, which includes wasps, yellow jackets and hornets. Hymenoptera are responsible for more deaths than any other venomous insects and pose a risk to the public due to the emergence of well-established populations of Africanized honeybees. These honeybees are prevalent in southwestern states such as Arizona. Africanized bees are more aggressive and take less to provoke stings than non-hybridized bees, and mass envenomations can cause fatal accidents. This study was a retrospective review of patient charts based on ICD-9 and ICD-10 records indicating massive honeybee envenomation and screened to include only patients meeting our inclusion criteria of ≥ 50 stings over a 10 year period at Banner – University Medical Center Phoenix. 25 total patients were included and epidemiological, clinical, and therapeutic data were obtained and compared for noticeable trends in the data with regard to demographics and comorbidities. The 25 patients ranged in age from 16 to 82 years old. Total number of stings varied from an estimated 50 stings, to over 1000. The majority of patients were estimated to have been stung by between 100 to 500 bees representing thirteen patients (52%). Four patients (16%) had a history of CAD, fourteen patients had hypertension (56%), nine patients had diabetes (36%), and one patient had asthma. In terms of outcomes, five patients (20%) required intubation for airway management, two patients were dialyzed (8%), and the average length of stay was 84.2 hours over the course of hospital admission. Our results showed that there was no obvious trend in the outcomes of patients with and without CAD, asthma, hypertension, and diabetes. Significant trends were primarily seen in the total number of stings sustained. In patients with a greater number of stings, the total length of stay increased dramatically. Number of stings also seemed to indicate a greater risk of requiring intubation as well. Finally, creatine kinase levels were also significantly elevated in patients with a higher sting count, supporting prior work done regarding the effect of mass envenomations with resulting rhabdomyolysis. This research supports that fact that ultimately the biggest determinant of a patient’s clinical course is the number of stings that they present with. It seems safe to assume that a mass envenomation on the scale of hundreds to thousands of stings will greatly increase the chance that this particular patient is going to have significant rhabdomyolysis, be at greater risk of requiring advanced airway measures such as intubation, and be admitted to the hospital for a longer period. Future work would be enhanced by implementing a multicenter review to increase the power of the study to allow for statistical comparisons to be made, creating an opportunity to delineate potential differences in outcomes based on comorbid conditions.