Snake bite wound in Children : Risk factors and outcome of surgical intervention

Abstract

Background: Snake bite is a common problem in rural areas. Children are treated by pediatricians and pediatric surgeons are often consulted for  wound care, some with need for surgical intervention.

Objective: to study the epidermiology of snake bite wounds, number needed for surgical intervention, risk factors and outcome of surgical intervention in children treated at Maharaj Nakhon Si Thammarat Hospital.

Material and Methods: Medical records in children aged 0 to 15 years, admitted with snake bite at Maharaj Hospital Nakhon Si Thammarat , from 1 january  2008 to 31 December  2016, were systematical reviewed.

Results: there was a total of 124 patients with male to female ratio 74 to 50. Age ranged from 10 months to 14 years (mean age 8.68 years). 80 patients (64 %) were from the city and nearby rural areas. 39 patients (31.5 %) were from other rural areas in the province and 5 patients (4 %) were referred from other nearby provinces. Identity of the snake was unknown in 63 cases (50.8 %), cobra snake in 31 patients (25 %) and Malayan pit viper snake in 30 patients (24.2%).  In 64 patients (51.6%) there was only local effect from the venom. 43 patients (34.7%) received antivenom.

115 patients(82.7%)  were treated with antibiotics.23 patients with cobra bite needed respiratory support. 2 patients had compartment syndrome. 49 patients developed wound complications and 26 patients (21.0%) needed surgical intervention. Surgical intervention was incision and drainage in 5 patients. 23 patients needed excisional debridement.

6 patients needed skin graft transplantation. 1 patients needed a below knee amputation. There were no fatal cases. Length of hospital stay was 1 to 45 days (mean 3.47 days). Duration of treatment and follow up until complete cure was 1 to 165 days (mean 12.28 days). Only 5 (6.25%) of the 80 patients who were from the city and nearby rural areas had complication from the snake bite wound that needed surgical intervention. We concluded that patients with the following risk factors: referred from outer rural areas, age less than 5 years, symptoms from local and systemic effect of the venom, cobra bite, prolonged VCT, need for antivenom and need for respiratory support, had more risk in needing surgical intervention than patients without these risk factors with statistical significance.

Conclusions : snake bite in children is a common problem and in need for surgical intervention in 6.25 percent of cases. Early observation and intervention by pediatric surgeon is needed in snake bite patients with the following risk factors : age less than 5 years, symptoms from local and systemic effect of the venom, cobra bite, prolonged VCT, need for antivenom and need for respiratory support.