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Surgical Considerations for Pediatric Snake Bites in Low- and Middle-Income Countries
Matthew C Hernandez1, Michael Traynor2, John L Bruce3
1Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Hernandez.matthew@mayo.edu.
Insights
Patient factors like shock index and low hemoglobin predict fasciotomy need in children after snake bites. Early identification and timely treatment, including antivenom, can reduce surgery requirements.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Clinical Surgery
Background:
- Snake envenomation causes significant morbidity, particularly in low- and middle-income countries.
- Fasciotomy may be required to manage complications of venomous snake bites.
- Identifying factors predicting fasciotomy need in pediatric snakebite victims is crucial for timely intervention.
Purpose of the Study:
- To determine patient factors associated with the need for fasciotomy in children following venomous snake bites.
- To identify predictors of surgical intervention in pediatric snake envenomation cases.
Main Methods:
- A retrospective review of clinical data from children (<18 years) treated for snake envenomation between 2012-2017 was conducted.
- Snake bite syndromes were classified using Blaylock nomenclature (progressive painful swelling, progressive weakness, bleeding).
- Multivariable analyses were performed to identify factors independently associated with the need for fasciotomy.
Main Results:
- Of 72 children, 18 (25%) required fasciotomy. Progressive painful swelling (PPS) was the most common syndrome (88%).
- Factors independently associated with fasciotomy included age-adjusted shock index, hemoglobin <11 mg/dL, presentation >24 hours post-bite, and INR >1.2.
- The predictive model demonstrated good fit with a sensitivity of 0.89.
Conclusions:
- Specific patient factors are significantly associated with the need for fasciotomy after snake envenomation in children.
- Clinical examination and identified factors can help in early identification of patients requiring operative intervention.
- Improving timely treatment and appropriate antivenom administration can potentially reduce the incidence of fasciotomy in pediatric snakebite cases.
Background:
Snake envenomation is associated with major morbidity especially in low- and middle-income countries and may require fasciotomy. We determined patient factors associated with the need for fasciotomy after venomous snake bites in children located in KwaZulu-Natal, South Africa.
Methods:
Single institutional review of historical data (2012-2017) for children (<18 years) sustaining snake envenomation was performed. Clinical data, management, and outcomes were abstracted. Syndromes after snake bite were classified according to Blaylock nomenclature: progressive painful swelling (PPS), progressive weakness (PW), or bleeding (B), as it is difficult to reliably identify the species of snake after a bite. Comparative and multivariable analyses to determine factors associated with fasciotomy were performed.
Results:
There were 72 children; mean age was 7 (±3) years, 59% male. Feet were most commonly affected (n = 27, 38%) followed by legs (n = 18, 25%). Syndromes (according to Blaylock) included PPS (n = 63, 88%), PW (n = 5, 7%), and B (n = 4, 5%). Eighteen patients underwent fasciotomy, and one required above knee amputation. Nine patients received anti-venom. Few patients (15%) received prophylactic beta-lactam antibiotics. Hemoglobin < 11 mg/dL, leukocytosis, INR >1.2, and age-adjusted shock index were associated with fasciotomy. On regression, age-adjusted shock index and hemoglobin concentration < 11 mg/dL, presentation >24 h after snake bite, and INR >1.2 were independently associated with fasciotomy. Model sensitivity was 0.89 and demonstrated good fit.
Conclusions:
Patient factors were associated with the fasciotomy. These factors, coupled with clinical examination, may identify those who need early operative intervention. Improving time to treatment and the appropriate administration of anti-venom will minimize the need for surgery.
Level Of Evidence:
III.
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