title: Risk factors for high-grade envenomations after French viper bites in children.
abstract: BACKGROUND
  Viper bites and subsequent evolution to severe envenomations are more frequent in children.
  
  
  OBJECTIVE
  The aims of this study were to describe the clinical, biological, and therapeutic characteristics of children bitten by vipers in France and to identify risk factors associated with severe envenomations.
  
  
  METHODS
  A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary-level children hospital. Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course.
  
  
  RESULTS
  Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years. Bites were most often located on the lower extremities (77%). The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high-grade (moderate to severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav). Being bitten on an upper extremity (P < 0.001), during the afternoon (P = 0.025), feeling violent pain (P = 0.037), and high initial glucose level (P = 0.016) were associated with a significant risk of high-grade envenomation. In the multivariate analysis, 3 factors remained significant: upper-extremity location (relative risk [RR], 60.5 [3.5-1040]; P = 0.005), immediate violent pain (RR, 21.5 [1.3-364.5]; P = 0.03), and female sex (RR, 17.5 [0.9-320.3]; P = 0.053).
  
  
  CONCLUSIONS
  A certain number of criteria seem related to more significant risk of progression to high-grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high-grade envenomation.
authors: Pediatric Emergency Department, Children Hospital, Toulouse, France. claudet.i@chu-toulouse.fr
authors: Isabelle
authors: I
authors: Claudet
authors: Céline
authors: C
authors: Maréchal
authors: Emmanuel
authors: E
authors: Gurrera
authors: Laurie
authors: L
authors: Cordier
authors: Raphaele
authors: R
authors: Honorat
authors: Erick
authors: E
authors: Grouteau
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000997:Antivenins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012909:Snake Bites / Q000145:classification* / Q000188:drug therapy / Q000628:therapy; D014757:Viper Venoms
chemical_list: D000997:Antivenins; D014757:Viper Venoms