Pediatric Snakebites: Comparative Analysis Using the National Trauma Database
Michael C. Johnson, MD1; Nilda Garcia, MD2; Ronald M. Stewart, MD1; Lillian F. Liao, MD1
1University of Texas Health San Antonio, San Antnoio, TX; 2Dell Children's Medical Center, Austin, TX
Background: Snakebites can result in severe local or systematic derangement. Pediatric snakebites are of concern given their smaller size can potentially result in an increased volume of envenomation. Data regarding snakebite injuries is predominated by adult research. We evaluated the National Trauma Database Research Data Set to compare pediatric and adult snakebites in regards to anti-venom use, rate of intervention, and outcomes.
Methods: Retrospective review using the National Trauma Database Research Data Set from 2012-2014. Pediatric age was defined as ages 1-17 and injury was defined using E-coding. Additional data included demographics, procedures and outcomes.
Results: Cohort consisted of 2143 subjects (629 children and 1514 adults) suffering from venomous snakebites. Mean age for children was 8.9 years. 65% were male, 85% were Caucasian, and 81% were non-Hispanic. 58% of patients were transferred and 30% required ICU stay. 45% were treated at a level I pediatric facility. Anti-venom was administered in 14% with 1% developing compartment syndrome requiring fasciotomy. For adults, 14% required anti-venom with 1% developing compartment syndrome requiring fasciotomy. There were no deaths in either population. Children were more likely to be injured on the lower extremity (69% versus 41%; p-value <0.001).
Conclusion: Comparisons between populations reveal striking similarities in the treatment and outcomes with a minority requiring anti-venom and/or fasciotomy. This reveals significant gaps in our knowledge in regards to the effects of envenomation and appropriate treatment of pediatric snakebites. Further prospective studies are necessary to quantify the role of anti-venom dosing in the pediatric population.
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