Pediatric snakebites: lessons learned from 114 cases.
OBJECTIVE
Evidence-based guidelines for the treatment of pediatric snakebite injuries are lacking because they occur infrequently in most centers.


METHODS
We reviewed our experience treating snakebites from January 1995 through December 2005. Demographic (eg, age, sex, geographic location) and clinical information (eg, location of bite, species of snake, vital signs, laboratories, treatment, hospital length of stay) were obtained.


RESULTS
Over the last decade, we have treated 114 children with confirmed snakebites. Mean age was 7.3 +/- 4.2 years (range, 1-17 years), and snakebites were more common in males (n = 68, 60%). All bites occurred on the extremities, and lower extremity bites were more common (n = 71, 62%). Copperheads inflicted the most bite injuries (n = 65, 57%), followed by rattlesnakes (n = 9, 8%) and cottonmouths (n = 7, 6%). The snake was not identified in 33 (29%) cases. Seven (6%) children were treated with Crotalidae antivenin. Of the children treated with antivenin, only 4 met criteria for treatment, and 1 had an anaphylactic reaction. If compartment syndrome was suspected based on neurovascular examination, compartment pressures were measured. Only 2 (1.8%) patients required fasciotomies. Over the last 2 years, we have stopped empiric treatment with antibiotics and have not observed any infectious complications. Average hospital length of stay was 30 +/- 25 hours.


CONCLUSIONS
Most children bitten by pit vipers can be managed conservatively with analgesics and elevation of the affected extremity. Treatment with Crotalidae antivenin, antibiotics, and fasciotomy is rarely indicated.
Campbell
Brendan T
BT
Department of Surgery, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA. bcampbell@ccmckids.org
Corsi
John M
JM
Boneti
Cristiano
C
Jackson
Richard J
RJ
Smith
Samuel D
SD
Kokoska
Evan R
ER
D000293:Adolescent; D001131:Arkansas; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012909:Snake Bites / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*