Received: January 1, 2009.

Accepted: June 15, 2009.

Abstract published online: June 22, 2009.

Full paper published online: November 30, 2009.

VENOMOUS SNAKEBITES AND ANTIVENOM TREATMENT ACCORDING TO A PROTOCOL FOR PEDIATRIC PATIENTS IN TAIWAN

Wang JD (1, 2), Tsan YT (3), Yan-Chiao Mao (3), Wang LM (3, 4, 5)

(1) Division of Pediatric Emergency, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; (2) Institute of Biochemistry and Biotechnology, Chung San Medical University, Taichung, Taiwan, Republic of China; (3) Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; (4) Division of Emergency Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; (5) Graduate Institute of Health Care Organization, National Taiwan University, Taipei, Taiwan, Republic of China

ABSTRACT: Children bitten by venomous snakes comprise emergency cases that present high morbidity and mortality, especially in some regions of Asia and Africa. Reports on clinical features and management of envenomated children are scarce. This observational study implemented a protocol for antivenom use in pediatric snakebite victims in Taiwan, between 1994 and 2007. The present work investigated demographics, clinical features and effects of antivenom therapy and the complications and prognosis for snakebites. A total of 55 children and adolescents, with a median age of 9.9 years (ranging from 2 to 18 years), was identified. Forty-five patients (82%) were bitten between May and September. Thirty-five patients (64%) received antivenom therapy, 28 of them (80%) within two hours after being bitten. No fatalities occurred and only five of 35 patients (14%) had major morbidity when treated according to the protocol. Thirty-one snakes (56%) were identified and 12 of them (38%) were Naja atra. This study indicates that a protocol for children affected by snakebites is valuable for guiding emergency physicians to treat these patients immediately. Further strategies are required to reduce the morbidity rate that occurs as a result of Naja atra bite.

KEY WORDS: snakebites, children, antivenom.

CONFLICTS OF INTEREST: There is no conflict.

CORRESPONDENCE TO:

LEE-MING WANG, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. Phone: 886 4 23592525, ext. 5929. Fax: 886 4 2374-1359. Email: jiaander@vghtc.gov.tw.