The role of thromboelastography in the management of children with snake-bite in southern Africa

In the absence of a direct laboratory test of envenomation, there is a need for an alternative mechanism for the early recognition of envenomation fol lowing snake-bite in children. A severe clinical diathesis may result eithe r from envenomation or from the release of an inappropriate tourniquet appl ied as 'first-aid' often several hours before presentation to hospital. Abn ormalities of clotting are associated with both events. A normal thromboela stogram (TEG) provides early recognition of patients in whom the clinical c ourse is likely to be benign (sensitivity = 94%). An abnormal TEG identifie s patients of whom 50% will develop a severe clinical diathesis. A TEG is a more accurate predictor of disease severity than International Normalized Ratio alone. The TEG does not supplant clinical observation in the manageme nt of snake-bite in children but allows stratification into high- and low-r isk categories.