Suspected snakebite in children: a study of 156 patients over 10 years

Objective To describe the epidemiology and clinical features of children presenting to an emergency department with suspected snakebite. Design A retrospective study of patient records. Setting An emergency department of a children's teaching hospital (Princess Margaret Hospital) in Perth, Western Australia. Participants All children attending the emergency department from 1984 to 1993 with suspected snakebite. Main outcome measure Clinical and laboratory evidence of envenomation. Results Over the decade studied, 156 children (mean age, six years and eight months) presented with suspected snakebite; over two‐thirds (68%) were boys. In at least 31% of cases, no appropriate first aid had been applied. Only 14 children were envenomed according to clinical and laboratory criteria: 10 of these had coagulopathy; one of the 10 also had rhabdomyolysis. A Venom Detection Kit was used in 117 children. The test gave a positive result in 21 children (13%). Antivenom was given to 18 children, 14 of whom were definitely envenomed. Four of the envenomed children returned a negative result of Venom Detection Kit testing at all sites tested, and in five patients not clinically envenomed the urine specimen tested positive with the Venom Detection Kit (presumably a false positive result or subclinical envenomation). Of the 156 children, 130 were admitted to hospital, and 26 were discharged directly from the emergency department. All children recovered completely. Conclusions (i) Many children did not receive appropriate first aid for snakebite; (ii) Most children with suspected snakebite presenting to the emergency department were not envenomed; (iii) Envenomation was best diagnosed by clinical features and laboratory investigations, with the Venom Detection Kit being used to determine the appropriate antivenom; (iv) Discharging children directly from the emergency department is not recommended.