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Scorpion Envenomation Among Children: Clinical Manifestations and Outcome (Analysis of 685 Cases)

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  • Service de Réanimation Médicale, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax Tunisie; Service de Pédiatrie Générale, Centre Hospitalo-Universitaire Hédi Chaker, Sfax, Tunisie
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Our objective was to characterize both epidemiologically and clinically manifestations after severe scorpion envenomation and to define simple factors indicative of poor prognosis in children. We performed a retrospective study over 13 years (1990–2002) in the medical intensive care unit (ICU) of a university hospital (Sfax-Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. The medical records of 685 children aged less than 16 years who were admitted for a scorpion sting were analyzed. There were 558 patients (81.5%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation [coma and/or convulsion]) and 127 patients (18.5%) in the grade II group (with systemic manifestations). In this study, 434 patients (63.4%) had a pulmonary edema, and 80 patients had a cardiogenic shock; neurological manifestations were observed in 580 patients (84.7%), 555 patients (81%) developed systemic inflammatory response syndrome (SIRS), and 552 patients (80.6%) developed multi-organ failure. By the end of the stay in the ICU, evolution was marked by the death in 61 patients (8.9%). A multivariate analysis found the following factors to be correlated with a poor outcome: coma with Glasgow coma score ≤ 8/15 (odds ratio [OR] = 1.3), pulmonary edema (OR = 2.3), and cardiogenic shock (OR = 1.7). In addition, a significant association was found between the development of SIRS and heart failure. Moreover, a temperature > 39°C was associated with the presence of pulmonary edema, with a sensitivity at 20.6%, a specificity at 94.4%, and a positive predictive value at 91.7%. Finally, blood sugar levels above 15 mmol/L were significantly associated with a heart failure. In children admitted for severe scorpion envenomation, coma with Glasgow coma score ≤ 8/15, pulmonary edema, and cardiogenic shock were associated with a poor outcome. The presence of SIRS, a temperature > 39°C, and blood sugar levels above 15 mmol/L were associated with heart failure.

Author Notes

*Address correspondence to Mabrouk Bahloul, Service de Réanimation médicale, Hôpital Habib Bourguiba, Route el Ain Km 1, 3029 Sfax, Tunisie. E-mail: bahloulmab@yahoo.fr

Authors' addresses: Mabrouk Bahloul, Anis Chaari, Kamilia Chtara, Hatem Kallel, Hassen Dammak, Hichem Ksibi, Hedi Chelly, Noureddine Rekik, Mounir Bouaziz, and Chokri Ben Hamida, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie, E-mails: bahloulmab@yahoo.fr, anischaari2004@yahoo.fr, kamilia.chtaraelaoud@gmail.com, kallelhat@yahoo.fr, hssandm@yahoo.fr, ksibi_hichem@yahoo.fr, hedi.chelly@rns.tn, noureddine.rekik@rns.tn, mounir.bouaziz@rns.tn, and chokri.benhamida@rns.tn. Imen Chabchoub, Service de Pédiatrie Générale, Centre Hospitalo-Universitaire Hédi Chaker, Sfax, Tunisie, E-mail: chabchoubimen@yahoo.fr.

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