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Clinical Features and Prognosis of Severe Scorpion Envenomation in Children.

BACKGROUND
Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in central area is Androctonus mauretanicus (Am) scorpion. Its envenomation can be lethal, especially for children. This study aimed to determine a clinico-epidemiological profile of severe scorpion envenomation (SSE) among children and identify risk factors for mortality.


METHODS
This retrospective cohort study included 606 children admitted for SSE from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital.


RESULTS
The mean age of envenomed children was 6.3 ± 4.2 years. Seventy-four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 hours in 83% of cases. Bivariate analysis indicated that from 1-24 months of age (p=0.001), hyperthermia (p=0.022), episodes of diarrhea (p<0.001), tachycardia (p<0.001), abdominal distention (p<0.001), skin marbling (p<0.001), signs of respiratory distress (p<0.001), irritability (p<0.001), generalized seizures (p=0.053), and GlasgowComa Score (GCS) of 3 to 9 (p<0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (p=0.007), skin marbling (p=0.006), respiratory distress (p=0.002), and GCS 3-9 (p=0.007) were found to be independent risk factors for mortality in our patient population.


CONCLUSION
Children are at high risk of developing serious complications, even death, from SSE. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.