An epidemiological and clinical study of snake‐bites in childhood

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Abstract
The last decade has seen major changes in the first-aid management of elapid snake-bites and the introduction of a new venom-detection kit which can identify the genus of medically-important snakes. In the light of these development, we report a 10-year study that comprised 218 consecutive children who were admitted to hospital in southeast Queensland, after a confirmed or a suspected snake-bite. One-third (34.9%) of victims were preschool children (zero to five year of age) but the highest "at-risk" group comprised prepubescent boys. In 70% of cases, the bite was on a single lower limb. Of the 218 children who were admitted to hospital, 42% manifested local or systemic symptoms that were consistent with a confirmed snake-bite, irrespective of whether or not the species of snake was venomous. A positive identification of the genus of the offending snake was established in 18.8% of cases. In 35.8% of cases, the Commonwealth Serum Laboratories'' Venom Detection Kit was used in an attempt to identify the involved snake, with 10 (4.6% of all cases) positive test-results. We have found that appropriate first aid was applied in the field in a maximum of 18% of cases. Antivenom was administered to 14 children, seven of whom received polyvalent antivenom; one child manifested a severe anaphylactic reaction. There were no fatalities in this series, and no permanent morbidity. An interpretation of our data suggests that the diagnosis of a snake-bite is confirmed in between 40%-70% of all children who are admitted to hospital for this reason. From this, we conclude that the age-specific incidence of snake-bite is in the range of 2.0-3.5 cases per 100,000 children annually.