Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
University of Tennessee College of Medicine, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
J Surg Res. 2021 Sep;265:297-302. doi: 10.1016/j.jss.2021.03.045. Epub 2021 May 6.
Management of children with snakebites may vary based on subjective criteria, geographic, and climatic factors. We reviewed the incidence and management of snakebite injuries in children at two tertiary referral centers in separate geographic and climatic location to assess differences in management and outcomes of these patients.
After institutional review board approval, a retrospective chart review was performed for patients ≤18 years with snakebite injuries at emergency departments (ED) of two American College of Surgeons verified trauma centers (2006-2013). One center is in southeast US and experiences a sub-tropical climate whereas the other is in southwest US and experiences a semi-arid climate. Demographic and clinical parameters were extracted.
A total of 108 patients (59% male), median age of 9 y (1 y-17 y), were included. Snake type was identified by bystanders in 55.5% cases; copperhead was the most common (37%) subtype. Approximately 30% of patients received antivenom. One quarter of all patients were discharged from the ED. Two patients received surgical intervention in the first 48 hours after presentation. Compared to patients who sustained a snakebite in semi-tropical regions, patients in semi-arid areas had shorter bite-to-ED time, presented directly to the referral center, were more frequently bitten by a rattlesnake, had longer lengths of hospital stay, required antivenom more frequently and at higher doses, and were more frequently admitted to the ICU. No differences were seen in gender, age at presentation, severity of wound, location of bite, abnormalities in coagulation profile or rate of admission to hospital amongst the two sites.
Patients sustaining snakebites in semi-arid climates were more commonly exposed to dangerous snake types, resulting in higher antivenom requirement, as well as longer hospital stays and need for intensive monitoring. Although no fatalities were reported in our study, our data supports early transfer of snakebite victims to higher levels of care, especially in semi-arid or high-risk areas.
儿童蛇伤的处理可能因主观标准、地理位置和气候因素而异。我们回顾了两个地理位置和气候条件不同的三级转诊中心的儿童蛇伤发生率和处理情况，以评估这些患者处理和结局的差异。
在机构审查委员会批准后，对在两家美国外科医师学会认证的创伤中心急诊科（2006-2013 年）就诊的≤18 岁蛇伤患者进行回顾性病历审查。一个中心位于美国东南部，气候为亚热带；另一个中心位于美国西南部，气候为半干旱气候。提取人口统计学和临床参数。
共纳入 108 例患者（59%为男性），中位年龄为 9 岁（1 岁-17 岁）。有 55.5%的患者由旁观者确定蛇的类型；最常见的蛇种是铜斑蛇（37%）。约 30%的患者接受了抗蛇毒血清治疗。所有患者中有四分之一在急诊科出院。两名患者在就诊后 48 小时内接受了手术干预。与在亚热带地区发生蛇伤的患者相比，在半干旱地区的患者从咬伤到就诊的时间更短，直接到转诊中心就诊，更常被响尾蛇咬伤，住院时间更长，更频繁地需要抗蛇毒血清治疗且剂量更高，更频繁地被收入重症监护病房。两个地点的患者在性别、就诊时年龄、伤口严重程度、咬伤部位、凝血异常或住院率方面无差异。
在半干旱气候中发生蛇伤的患者更常接触到危险的蛇类，导致抗蛇毒血清需求增加，住院时间延长，需要加强监测。尽管在我们的研究中没有报告死亡病例，但我们的数据支持将蛇伤患者尽早转移到更高水平的医疗机构，特别是在半干旱或高风险地区。
