Application of Downey classification used in the diagnosis and treatment of children's snakebite / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the application of Downey classification and to improve the diagnosis and treatment for children bitten by venomous snakes.Methods The consecutive 76 snakebite children were treated according to the guidance of Downey classification in Children's Hospital of Chongqing Medical University from Jan.2005 to Dec.2011.Their epidemiological and clinical characteristics,treatment and outcomes were reviewed and analyzed.The Chinese traditional classification method was adopted to classify children of snakebites as a contrast at the same time,and the correlation of the 2 methods was studied.Correlations in Downey level,treatment time,length of hospital stay,osteofascial compartment syndrome (OCS) and the occurrence of myocardial damage were studied respectively.Results The 76 cases of snakebites all occurred from Apr.to Nov.,the time of injuries focused on the period of 18:01 to 00:00 (60 cases,78.94％),and limbs were the main injury parts(73 cases,96.05％).According to Downey's system,patients of grade 0 were 3 cases (3.95 ％),grade Ⅰ were 9 cases (11.84％),grade Ⅱ were 26 cases (34.21％),grade Ⅲ were 30 cases (39.47 ％),and grade Ⅳ were 8 cases (10.53 ％).All children victims were given comprehensive and symptomatic treatment,in which 74 cases were clinically cured and 2 cases were disabled,but no deaths.There was positive correlation between the traditional classification method and Downey classification method (r=0.85,P ＜ 0.05),and there was also positive correlation between treatment time and length of hospital stay (r =0.91,P ＜ 0.05).There was positive correlation between Downey level and OCS,the occurrence of myocardial damage,treatment time and length of hospital stay(r =0.90,0.95,0.48,0.96,respectively,all P ＜ 0.05).Conclusions The diagnosis and treatment were more specified after using the Downey classification,snake venom poisoning in children is a medical emergency requiring immediate attention,early diagnosis and proper treatment can reduce its fatality and disability rate.