P. N. Chotai1, J. R. Watlington2, S. Lewis3, T. Pyo3, A. A. Abdelgawad4, E. Y. Huang5 1Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 2University Of Tennessee Health Science Center,College Of Medicine,Memphis, TN, USA 3Texas Tech University Health Science Center,School Of Medicine,El Paso, TX, USA 4Texas Tech University Health Science Center,Department Of Orthopedic Surgery,El Paso, TX, USA 5University Of Tennessee Health Science Center,Division Of Pediatric Surgery, Department Of Surgery,Memphis, TN, USA
Introduction:
Management of children with snakebites may vary based on subjective criteria and 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.
Methods:
An institutional review board approved, retrospective chart review was performed for patients ≤18-year-old with ICD-9/E-codes for snakebite injuries at emergency department (ED) of two American College of Surgeons verified trauma centers (2006-2013). One center is located in south-east US and experiences a sub-tropical climate whereas the other is located in south-west US and experiences a semi-arid climate. Demographic and clinical parameters were extracted. Descriptive bivariate analysis using chi-square or Fisher exact test for nominal variables and Mann-Whitney U test for continuous variables was performed.
Results:
A total of 108 patients(59% male), median age of 9y(1y-17 y), were included. Snake type was identified by bystanders in 55.5% cases; copperhead was the most common(37%) subtype. About 30% patients received antivenin. One quarter of all patients were discharged from ED. Of the 83 admitted, 81% were admitted to floor and 19% were observed in the intensive care unit (ICU). Two patients received surgical intervention in 48 hours after presentation (fasciotomy for lower extremity rattlesnake bite and blister removal on thumb from unidentified snake bite). There was one gastrointestinal complication (emesis), one cardiovascular (premature atrial contractions, benign) and one neurologic (paresthesia at bite site). All patients were discharged home with one 30-day re-admission for unrelated trauma. There were no fatalities. 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 length of hospital stay, required antivenin more frequently and at higher doses, and were more frequently admitted to the ICU (table 1). 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.
Conclusion:
Patients sustaining snakebites in semi-arid climates were more commonly exposed to dangerous snake types, resulting in higher antivenin requirement, as well as longer hospital stays and need for intensive monitoring. Although no fatalities were reported in our study, our data support early transfer of snakebite victims to higher centers of care, especially in semi-arid or high-risk areas.
