Snake bite mortality in children: beyond bite to needle time

• Published in: Archives of disease in childhood Vol. 102; no. 5; pp. 445 - 449
• Main Authors: Jayakrishnan, MP, Geeta, MG, Krishnakumar, P, Rajesh, TV, George, Biju
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2017; BMJ Publishing Group LTD
• Subjects: Acute kidney failure; Acute Kidney Injury - etiology; Acute Kidney Injury - mortality; Acute renal failure; Admission Criteria; Age groups; Anemia; Animals; Antivenins - administration & dosage; Antivenins - therapeutic use; Attrition (Research Studies); Capillary Leak Syndrome - etiology; Capillary Leak Syndrome - mortality; Care and treatment; Child; Child, Preschool; Children; Daboia; Death; Drug Administration Schedule; Epidemiology; Female; Health aspects; Hospitals; Humans; India - epidemiology; Infant; Intensive Care Units, Pediatric; Kidneys; Leukocytosis; Leukocytosis - etiology; Leukocytosis - mortality; Male; Malnutrition; Mortality; Multivariate analysis; Neurotoxicity; Observational studies; Prognosis; Risk factors; Snake bites; Snake Bites - complications; Snake Bites - mortality; Snake Bites - therapy; Snakes; Statistical Analysis; Statistical Significance; Venom; Viperidae; Southeast Asia; India; Intensive Care; Mortality; Tropical Paediatrics
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/archdischild-2016-311142

ObjectiveTo study the clinical characteristics and predictors of mortality from snake bite envenomation in children.DesignProspective observational study with a one-group cohort design.SettingPaediatric intensive care unit of a tertiary care hospital in South India.SubjectsThe study cohort consisted of 145 children (55 girls and 90 boys) <12 years of age with snake bite envenomation.MethodsDemographic and clinical details were recorded in a semistructured pro forma. Children were treated with polyvalent antisnake venom (ASV) as per WHO protocol. Details of treatment, complications and outcomes were recorded. Univariate analysis was done to identify statistical significance, and those variables found to be significant were analysed using binary logistic regression.ResultsRussell's viper was the most common offending snake followed by hump-nosed pit viper. Features of haemotoxicity, neurotoxicity and combined haemotoxicity and neurotoxicity occurred in 68 (47%), 39 (26.9%) and 9 (6%) children, respectively. Acute kidney injury (AKI) occurred in 36 (25%) children. The mortality rate was 10.3%. On univariate analysis, nocturnal bites, severe leucocytosis on day 1, AKI, capillary leak syndrome and a need for more than 20 vials of ASV were significantly associated with mortality. On multivariate analysis, only severe leucocytosis on day 1 (OR 35.29; 95% CI 1.37 to 911.89) and AKI (OR 35.05 95% CI 1.74 to 706.93) were found to be independent predictors of mortality.ConclusionsThis study has identified two hitherto unrecognised risk factors—severe leucocytosis on day 1 and capillary leak syndrome. These findings need to be taken into consideration when planning management strategies for snake bite envenomation in children.