@article{ref1,
title="Retrospective hospital-based cohort study on risk factors of poor outcome in pediatric snake envenomation",
journal="Journal of tropical pediatrics",
year="2020",
author="Suryanarayana, Ganapathi and Rameshkumar, Ramachandran and Mahadevan, Subramanian",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND AND OBJECTIVES: Among Southeast Asian countries, India has reported the highest mortality due to snakebite envenomation. To identify the risk factors of poor outcome (mortality/mechanical ventilation/renal replacement therapy-RRT) in pediatric snakebite envenomation.   METHOD: Case records of children aged less than 13 years with snakebite envenomation admitted between June 2009 and July 2015 were reviewed retrospectively. Medical records of the patient died within 6 h, those required RRT before administration of antisnake venom (ASV), and those with unknown bites were excluded.   RESULTS: A total of 308 patients were included. One hundred eighty (58.4%) had hemotoxic, and 128 (41.6%) had neuroparalytic envenomation. Median (interquartile range) bite to ASV time was 3 (2-6) h. Seventy-five (24.4%) patients received ASV within 6 h of bite. Poor outcomes occurred in 128 (41.6%), and 36 (11.7%) patients died. On binary logistic analysis (adjusted odds ratio, 95% confidence interval), age ≤5 years (2.97, 1.28-6.90), walking (6.15, 2.88-13.17), playing (3.36, 1.64-6.88), no tourniquet (2.39, 1.25-4.57), time to ASV more than 6 h (2.71, 1.45-5.06), fang marks (2.22, 1.21-4.07), neurotoxic envenomation (3.01, 1.11-8.13) and additional ASV dose (8.41, 2.99-23.60) were independently predicted the poor outcome (Hosmer and Lemeshow goodness of fit model p = 0.135; overall percentage of the model is 72.2% and R-square = 0.28).   CONCLUSION: Age below 5 years, activity at/after the bite (playing/walking), no tourniquet, a longer bite to ASV time, presence of fang marks, neurotoxic envenomation and need for additional ASV dose were independent predictors of poor outcome in pediatric snakebite envenomation.<p /> <p>Language: en</p>",
language="en",
issn="0142-6338",
doi="10.1093/tropej/fmaa078",
url="http://dx.doi.org/10.1093/tropej/fmaa078"
}