Venomous snakebites in children and adolescents: a 12 year retrospective review

RESUMO

Snakebite envenomation is a worldwide problem and in Costa Rica. The following is a retrospective review of 79 patients admitted to the Hospital Nacional de Ninos (HNN) from January 1985 to September 1996. Child's age ranged from 9 months to 14 years. The M: F ratio was 1.5:1. Sixty percent of the patients lived in remote rural areas. The most common clinical signs at the time of hospitalization were pain and edema. Fifty patients (63.29 per cent) showed moderate to severe envenomation grades. Fifty-one (64,55 per cent) was caused by Bothrops asper. Complications during hospitalization were compartment syndrome and secondary infection. Three children died, one from disseminated intravascular coagulation, another from renal insufficiency, and the third from a perforated duodenal ulcer. Patients who underwent early fasciotomy had signficantly less hospitalization and fewer infectious complications, (p<0.001). There was no relationship between the envenomation grade and length of hospitalization (p=0.4). The most common pathogen isolated was S. aureus. Early fasciotomy seemed to reduce the complications seen in these patients. Further studies are necessary to identify the factors that may clinicians to decide those who should undergo fasciotomy, as well as the best moment to perform it