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Snakebite poisoning in children--a call for unified clinical guidelines
R Ben Abraham1, E Winkler, G Eshel
1Department of Pediatric Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Treatment for children with Vipera palaestinae snakebites lacks uniform guidelines in Israel. Routine pediatric intensive care unit (PICU) admission is often unjustified, especially with new antivenom availability.
Area of Science:
- Toxicology
- Pediatrics
- Clinical Medicine
Background:
- Vipera palaestinae is the most common venomous snake in Israel.
- No standardized treatment protocols exist for pediatric snakebites in Israel.
Purpose of the Study:
- To compare snakebite treatment policies for children across two Israeli medical centers.
- To identify variations in clinical management and assess the necessity of current treatment practices.
Main Methods:
- Retrospective study design.
- Analysis of treatment data from two distinct medical centers.
- Comparison of admission criteria, steroid administration, and antivenom use.
Main Results:
- Significant variations observed in admission and steroid administration criteria between centers.
- Substantial, though not statistically significant, differences in antivenom administration practices.
- Neither center demonstrated a consistently well-defined treatment policy for pediatric snakebites.
Conclusions:
- Current treatment policies for Vipera palaestinae envenomation in children are inconsistent.
- Routine PICU admission for pediatric snakebites may be unnecessary, particularly with effective antivenom available.
- Development of uniform national guidelines for pediatric snakebite management is recommended.
Abstract:
In Israel, there are no uniform guidelines for the treatment policy of children snake-bitten by the Vipera palaestinae, the most abundant venomous snake in the country. We conducted a retrospective study aiming to compare treatment policies in two different medical centers. We found significant differences regarding admission and steroid administration criteria. Although the differences between the centers regarding anti-venom administration did not reach statistical significance, there were substantial differences. Neither of the centers had a well-established policy for the treatment of snake envenomation in children. In the era of cost containment, a policy of routine admission of children to the PICU service following V. palaestinae envenomation is unjustified, especially since the introduction of a specific monovalent anti-venom into the therapeutic armamentarium.