Development of the pediatric Crotalid envenomation score guideline and its influence on resource utilization

Pediatric crotalid snakebites cause serious morbidity. Current management is not tailored for pediatric patients and involves costly intensive care unit (ICU) hospitalization and antivenom administration. We assessed outcomes and resource utilization after implementing our pediatric-specific snakebite treatment guideline.

A multidisciplinary team developed the Pediatric Crotalid Envenomation Score (CES) Guideline. The guideline utilized retrospective data from a single pediatric hospital between 2008 and 2018. Patients were retrospectively triaged into three categories (CES 0, CES 1, CES 2) based on labs and physical exam to direct future admission location and antivenom dosing. Data was collected prospectively from 2019 to 2022. Pre-guideline and post-guideline variables included demographics, snake species, coagulation labs, physical exam findings, antivenom vials, readmissions, and hospital and ICU length of stay (LOS). Outcome comparison for pre-guideline and post-guideline cohorts included hospital and ICU LOS, antivenom utilization, readmission, and adverse reactions.

The pre-guideline cohort included 76 patients and the post-guideline cohort included 35. The entire post-guideline cohort had significant reduction in ICU admissions (63 % vs 84 %, p = 0.012) and ICU LOS by 66 % (p = 0.043). Stratification by CES demonstrated significant reductions in post-guideline ICU admissions for CES 0 and CES 1 (70 % vs 25 %, p = 0.043; 83 % vs 46 %, p = 0.013, respectively), reduction in antivenom vials for CES 0 (10 vs 0, p = 0.030), and reduction in ICU LOS by 0.7, 0.3, and 0.4 days for CES 0, 1, and 2, respectively. Overall hospital LOS, readmissions, and adverse reactions were similar between groups.

The Pediatric Crotalid Envenomation Score Guidelines conserves valuable resources and maintains excellent outcomes.

Level III.