Factors Affecting Outcome In Children With Snake Envenomation: A Prospective Observational Study

ObjectivesTo evaluate clinical outcome and factors affecting outcome in children with snake envenomation.DesignProspective observational study.SettingPaediatric intensive care unit of a tertiary care teaching hospital in India.PatientsWe prospectively enrolled children 12years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010.Measurements and Main ResultsDemographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1km after the bite, vomiting, haemoglobin 10g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin 10g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant.ConclusionsYounger age at presentation, anaemia (haemoglobin 10g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.