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Risk Factors for High-Grade Envenomations After French Viper Bites in Children
Pediatric Emergency Care, 07/11/2012
Clinical Article
Claudet I et al. – A certain number of criteria seem related to more significant risk of progression to high–grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high–grade envenomation.
Methods- A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary–level children hospital.
- Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course.
- Fifty–eight children were included (43 boys, 15 girls).
- The mean age was 7.8±4.1years.
- Bites were most often located on the lower extremities (77%).
- The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high–grade (moderate to severe envenomations).
- All high–grade envenomations received specific immunotherapy (Viperfav).
- Being bitten on an upper extremity (P<0.001), during the afternoon (P=0.025), feeling violent pain (P=0.037), and high initial glucose level (P=0.016) were associated with a significant risk of high–grade envenomation.
- In the multivariate analysis, 3 factors remained significant: upper–extremity location (relative risk [RR], 60.5 [3.5–1040]; P=0.005), immediate violent pain (RR, 21.5 [1.3–364.5]; P=0.03), and female sex (RR, 17.5 [0.9–320.3]; P=0.053).