Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India.
J Trop Pediatr. 2021 Jan 29;67(1). doi: 10.1093/tropej/fmaa078.
Among Southeast Asian countries, India has reported the highest mortality due to snakebite envenomation. To identify the risk factors of poor outcome (mortality/mechanical ventilation/renal replacement therapy-RRT) in pediatric snakebite envenomation.
Case records of children aged less than 13 years with snakebite envenomation admitted between June 2009 and July 2015 were reviewed retrospectively. Medical records of the patient died within 6 h, those required RRT before administration of antisnake venom (ASV), and those with unknown bites were excluded.
A total of 308 patients were included. One hundred eighty (58.4%) had hemotoxic, and 128 (41.6%) had neuroparalytic envenomation. Median (interquartile range) bite to ASV time was 3 (2-6) h. Seventy-five (24.4%) patients received ASV within 6 h of bite. Poor outcomes occurred in 128 (41.6%), and 36 (11.7%) patients died. On binary logistic analysis (adjusted odds ratio, 95% confidence interval), age ≤5 years (2.97, 1.28-6.90), walking (6.15, 2.88-13.17), playing (3.36, 1.64-6.88), no tourniquet (2.39, 1.25-4.57), time to ASV more than 6 h (2.71, 1.45-5.06), fang marks (2.22, 1.21-4.07), neurotoxic envenomation (3.01, 1.11-8.13) and additional ASV dose (8.41, 2.99-23.60) were independently predicted the poor outcome (Hosmer and Lemeshow goodness of fit model p = 0.135; overall percentage of the model is 72.2% and R-square = 0.28).
Age below 5 years, activity at/after the bite (playing/walking), no tourniquet, a longer bite to ASV time, presence of fang marks, neurotoxic envenomation and need for additional ASV dose were independent predictors of poor outcome in pediatric snakebite envenomation.
在东南亚国家中，印度因蛇伤中毒导致的死亡率最高。本研究旨在确定儿童蛇咬伤不良结局（死亡率、机械通气、肾脏替代治疗）的危险因素。
回顾性分析 2009 年 6 月至 2015 年 7 月收治的年龄小于 13 岁、有蛇咬伤史的患儿病历资料。排除 6 h 内死亡、使用抗蛇毒血清（ASV）前需行肾脏替代治疗、咬伤原因不明的患者。
共纳入 308 例患者。180 例（58.4%）为血液毒素型，128 例（41.6%）为神经毒素型。咬伤至注射 ASV 的中位时间为 3（2-6）h。75 例（24.4%）患者在咬伤后 6 h 内接受了 ASV 治疗。128 例（41.6%）出现不良结局，36 例（11.7%）死亡。二元逻辑分析（调整优势比，95%置信区间）显示，年龄≤5 岁（2.97，1.28-6.90）、行走（6.15，2.88-13.17）、玩耍（3.36，1.64-6.88）、未使用止血带（2.39，1.25-4.57）、注射 ASV 时间超过 6 h（2.71，1.45-5.06）、有牙痕（2.22，1.21-4.07）、神经毒性型中毒（3.01，1.11-8.13）和需要追加 ASV 剂量（8.41，2.99-23.60）是不良结局的独立预测因素（Hosmer 和 Lemeshow 拟合优度模型 p=0.135；模型总体百分比为 72.2%，R 平方=0.28）。
年龄小于 5 岁、咬伤后活动（玩耍/行走）、未使用止血带、咬伤至注射 ASV 时间延长、有牙痕、神经毒性型中毒和需要追加 ASV 剂量是儿童蛇咬伤不良结局的独立预测因素。
