PDF(Pubmed)
Abstract：
Snakebite envenoming is an important public health issue in many tropical and subtropical countries, where the burden of morbidity and mortality falls particularly on impoverished rural communities. Children are an especially vulnerable group. This scoping review provides an overview of the extent, type and content of peer-reviewed evidence regarding factors associated with mortality in snakebite-envenomed children. A comprehensive literature search of MEDLINE and the Global Index Medicus yielded 623 articles, of which 15 met the criteria for inclusion; 67% of studies were conducted in India, with the remaining studies taking place in Papua New Guinea, Morocco and The Gambia. There was a notable scarcity of eligible studies from sub-Saharan Africa and Latin America despite the high burden of envenoming in these regions. The risk factors for mortality that were identified by the greatest number of studies were younger patient age (n=4), delay in administration of antivenom (n=4) and acute kidney injury (n=3). Identification of poor prognostic factors can assist clinicians in making timely referrals to centres with paediatric critical care capability. Future research must address the lack of studies from key geographical regions so that evidence-based improvements to the care of this vulnerable group can be implemented.
摘要：
在许多热带和亚热带国家，蛇咬伤是一个重要的公共卫生问题，在那里，发病率和死亡率的负担尤其落在贫困的农村社区。儿童是一个特别脆弱的群体。本范围审查概述了范围，关于毒蛇咬伤儿童死亡率相关因素的同行评审证据的类型和内容。对MEDLINE和全球指数Medicus进行了全面的文献检索，共发表了623篇文章，其中15项符合纳入标准；67%的研究在印度进行，其余的研究在巴布亚新几内亚进行，摩洛哥和冈比亚。撒哈拉以南非洲和拉丁美洲的合格研究明显缺乏，尽管这些地区的研究负担很高。通过大量研究确定的死亡危险因素是年龄较小的患者（n=4），抗蛇毒血清给药延迟（n=4）和急性肾损伤（n=3）。确定不良预后因素可以帮助临床医生及时转诊至具有儿科重症监护能力的中心。未来的研究必须解决关键地理区域缺乏研究的问题，以便可以对这一弱势群体的护理实施基于证据的改进。
