Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India.
Arch Dis Child. 2013 Aug;98(8):596-601. doi: 10.1136/archdischild-2012-303025. Epub 2013 May 28.
To evaluate clinical outcome and factors affecting outcome in children with snake envenomation.
Prospective observational study.
Paediatric intensive care unit of a tertiary care teaching hospital in India.
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.
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.
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.
评估儿童蛇咬伤的临床结果和影响结果的因素。
前瞻性观察性研究。
印度一家三级教学医院的儿科重症监护病房。
我们前瞻性地招募了 2007 年 8 月至 2010 年 6 月期间因明确的蛇咬伤而入住我院的≤12 岁儿童。
将纳入儿童的人口统计学特征和临床过程记录在一个结构化的表格中，并使用适当的统计方法进行分析。儿童按照世界卫生组织（2005 年）关于儿童蛇咬伤管理的指南进行治疗。在 110 名研究儿童中，77 名（69%）为男性。大多数（72 名；64.2%）表现出主要的血液毒性中毒症状，而 20 名（18%）和 18 名（16%）儿童分别表现出神经毒性中毒和局部受累的症状。14 名儿童（13%）死亡，13 名（12%）有严重残疾。单变量分析显示，以下院前和入院变量与不良结局显著相关：年龄、咬伤后行走>1 公里、呕吐、入院时血红蛋白≤10 g/dl 和蛇种（眼镜蛇）。多变量分析显示，只有年龄较小（调整后的 OR 0.85；95%CI 0.7 至 0.9）、咬伤后行走>1 公里（调整后的 OR 57；95%CI 4.2 至 782）和入院时血红蛋白≤10 g/dl（调整后的 OR 6；95%CI 2 至 18.2）仍然显著。
就诊时年龄较小、贫血（血红蛋白≤10 g/dl）和咬伤后行走距离可能是儿童蛇咬伤死亡和发病的独立预测因素。这些蛇咬伤受害者的特征需要早期转介并在三级护理中心进行管理。
