The role of thromboelastography in the management of children with snake-bite in southern Africa.
In the absence of a direct laboratory test of envenomation, there is a need for an alternative mechanism for the early recognition of envenomation following snake-bite in children. A severe clinical diathesis may result either from envenomation or from the release of an inappropriate tourniquet applied as 'first-aid' often several hours before presentation to hospital. Abnormalities of clotting are associated with both events. A normal thromboelastogram (TEG) provides early recognition of patients in whom the clinical course is likely to be benign (sensitivity = 94%). An abnormal TEG identifies patients of whom 50% will develop a severe clinical diathesis. A TEG is a more accurate predictor of disease severity than International Normalized Ratio alone. The TEG does not supplant clinical observation in the management of snake-bite in children but allows stratification into high- and low-risk categories.
Hadley
G P
GP
Department of Paediatric Surgery, University of Natal, Durban, South Africa. hadley@med.und.ac.za
McGarr
P
P
Mars
M
M
D002648:Child; D006801:Humans; D019934:International Normalized Ratio; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012909:Snake Bites / Q000097:blood* / Q000628:therapy; D012910:Snake Venoms / Q000097:blood*; D013019:South Africa; D013916:Thrombelastography
D012910:Snake Venoms