Accidente ofi ́dico en niños en Costa Rica: epidemiologi ́a y deteccio ́n de factores de riesgo en el desarrollo de absceso y necrosis

Abstract

P. Saborio, M. González and M. Cambronero. Snakebites in children in Costa Rica: epidemiology and risk factors related to the occurrence of abscess and necrosis in 80 cases. Toxicon 36, 359–366, 1998.—A retrospective epidemiological analysis is presented of 80 snakebites in children admitted to the Pediatrics Service of Tony Facio Hospital in Limón, Costa Rica, between 1985 and 1995. An overall incidence rate of 20 snakebite accidents per 100,000 inhabitants per year was calculated for the region in that period. However, a higher incidence was described in some counties (36 and 30 cases per 100,000 inhabitants in Talamanca and Siquirres, respectively). Most of the cases occurred in February and November, between 16:00 and 19:00 hr. The mean age of the affected children was 8.67±2.66 years. No significant difference was found between genders. Thirty-three children affected (41.2%) were members of the local indigenous groups and 31 (38.8%) were residents of Talamanca County. The species of snake responsible were identified in 58.4% of cases, with Bothrops asper being the most important. The lower extremities were the most important primary site affected (86.3%). The most common clinical complications described in the study group were abscess formation (11.25%), necrosis (10%), renal failure (3.75%), compartmental syndrome (2.5%) and anaphylactic shock (1.25%). The overall mortality was 2.5%. Statistical analysis of the risk factors relating to the two most common complications showed that the condition of coming from Talamanca County ( P=0.02), damage in the proximal extremities ( P=0.02), a prothrombin time <2% ( P=0.01) and serum fibrinogen levels <100 g/dl ( P=0.01) were risk factors for the development of abscesses. The grade of severity of the snakebite ( P=0.018) and serum fibrinogen levels <100 g/dl were associated with development of necrosis. All of the patients with necrosis and abscesses also experienced two or more of the risk factors that correlated with a sensitivity of 100% and a specificity of 67% for the development of abscess, and 87% sensitivity and 88% specificity for necrotic complications. According to these data, snakebite complications are a relevant health problem in Costa Rica.