Written by Catherine Burger
Spoon Feed
In this retrospective study performed at two tertiary care pediatric hospitals in Tennessee, the authors found no difference in hospital length of stay or need for surgery between children given antivenom for snake envenomation compared to those who were not given antivenom.
Anti-antivenom?
The authors of this retrospective study reviewed the charts of all children admitted for snake envenomation to Le Bonheur Children’s Hospital (LBCH, n=123) in Memphis and Monroe Carell Jr. Children’s Hospital at Vanderbilt (MCJCHV, n=60) in Nashville from 2009-2021. Because the two hospitals differed significantly in snake bite treatment practice, the authors compared outcomes of the two hospitals to each other for statistical analysis. Children admitted to LBCH for snake envenomation were given antivenom 25% of the time with an average of 1 vial administered, compared to children admitted to MCJCHV, who were given antivenom 82% of the time with an average of 8 vials administered. Patient age, snake type, time from bite to ED presentation, body part envenomated, presence of extremity swelling, and presence of blebs and blisters were similar between the two hospitals. Coagulopathy was more common on ED work up at LBCH (32%) compared to MCJCHV (17%). Each hospital had similar timing from ED arrival to antivenom administration when given. Average length of stay and percentage of patients requiring surgery was similar between the two hospitals – LBCH 1.5 days and 3.3%; MCJCHV 1.8 days and 5%. During admission, worsening swelling and progression of blisters was more often documented at MCJCHV (42% and 33%) compared to LBCH (24% and 11%). The authors highlight many limitations to the study. The analysis compared two hospital practice styles as opposed to administration of a specific treatment, small sample size, nearly all bites were copperheads local to the southeastern U.S., and that they were unable to examine outcomes after hospital discharge (such as return to function time).
How will this change my practice?
I still plan to discuss snake envenomations with my local toxicology team; however, the results of this study will make me consider observation admission without antivenom a potentially reasonable option.
Source
Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children. Pediatr Emerg Care. 2024 Nov 1;40(11):e270-e276. doi: 10.1097/PEC.0000000000003245. Epub 2024 Jul 23. PMID: 39043166
