Factors affecting outcome in children with snake envenomation: a prospective observational study

Abstract

Objectives To evaluate clinical outcome and factors affecting outcome in children with snake envenomation. Design Prospective observational study. Setting Paediatric intensive care unit of a tertiary care teaching hospital in India. Patients We prospectively enrolled children ≤12 years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010. Measurements and Main Results Demographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1 km after the bite, vomiting, haemoglobin ≤10 g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1 km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin ≤10 g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant. Conclusions Younger age at presentation, anaemia (haemoglobin ≤10 g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.

Snake bite mortality in children: beyond bite to needle time

“…The clinical features and complications noted in our sample are comparable with the findings from previous studies in children and adults 3 8 9…”

Snake bite in Children: A retrospective study in a tertiary care centre in Southern India

“…This correlates with various studies with higher incidence in males. This is consistent with various adult as well as pediatric studies with69% males in study by Sankar et al, 68% males by Schulte et al, 60.55% males and male to female ratio of 1.5:1 by Halesha B.R et al [7][8][9] . Lower extremity is the most commonly bitten site and is comparable to other studies around 70 to 80% 6,9-12 .…”

Classifying snakebite in South Africa: Validating a scoring system

“…Age, coagulation abnormalities, low haemoglobin, leukocytosis, thrombocytopenia and delays to treatment are all correlated with adverse outcomes in the Asian and North American viper species. [8,11,12,21,22] It is notable that acute kidney injury is a significant factor in Indian snakebites, while we found no correlation with severity and in our setting acute kidney injury is seldom reported. [16,18,19] One study from southern India reported acute kidney injury in 28% of snakebite patients, with a significant association with mortality.…”