Diagnosis and treatment of confirmed and suspected snake bite. Implications from an analysis of 46 paediatric cases.

OBJECTIVE

To identify reliable predictors of envenomation in suspected snake bite and to examine the current standard of treatment in envenomed patients.

DESIGN

Retrospective cohort analysis of children presenting with suspected or confirmed snake bite in southern mainland Australia. Detection of snake venom in urine or blood was taken as proof of envenomation.

SETTING

Intensive Care Unit, Royal Children's Hospital, Melbourne.

PATIENTS: Forty-six children presenting between 1979 and 1990.

MAIN OUTCOME MEASURES: Positive and negative clinical evidence, venom tests, and coagulation tests.

RESULTS

Twenty-seven children (59%) had suspected bites; 10 (22%) were bitten but not envenomed; 9 (19%) were envenomed. Two died of coagulopathy. Headache, abdominal pain or vomiting were moderately predictive of envenomation (positive predictive values of 63%, 57% and 64% respectively). Coagulopathy was a highly sensitive, specific and reliably predictive (100%) indicator of envenomation. The pressure-immobilisation bandage was used in 28% of cases at the scene of the bite and in 41% on contact with medical or paramedical services. Twelve patients received antivenom; of these, six received adrenaline as premedication.

CONCLUSION

Headache, abdominal pain, nausea or vomiting, or abnormal coagulation tests accurately predict envenomation by snakes in southern mainland Australia. More or better education on first aid and clinical management of snake bite is needed.