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Triage for Leiurus quinquestriatus scorpion envenomation in children —is routine ICU hospitalization necessary?

G Eshel

E Winkler

Department of Pediatric Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Israel

A A Weinbroum

Department of Anesthesiology and Intensive Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel

Z Barzilay

Department of Pediatric Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Israel

G Paret

Department of Pediatric Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

(1) Leiurus quinquestriatus scorpion (LQS) envenomtion is a common public health problem with a similar clinical presentation in the Middle East and worldwide: localized reactions occur in up to 97% of the victims. (2) LQS envenomation in children is potentially fatal since the severity of symptoms is weight-dependent. (3) A common policy is to hospitalize all children stung by the LQS egardless of clinical severity in the pediatric intensive care unit (PICU). (4) Seventeen of 18 children treated at two Israeli medical centers during an 8-year period developed mild to moderate clinical manifestations (antivenin was given in the one severe case; all children survived): all 18 had been transferred to an ICU for surveillance. Since patient care in PICUs is far more costly and manpower-intense than in general emergency rooms, we propose that a protocol of 6 h of surveillance in the emergency department is adequate and safe for most children who had been stung by LQS. Only children who develop systemic manifestations should be hospitalized and transferred to the intensive care unit. (5) Further prospective studies should be conducted to define specific subgroups that may benefit from these recommendations.

Key Words: Leiurus quinquestriatus • scorpion • envenomation • children • costs

Human & Experimental Toxicology, Vol. 19, No. 12, 663-666 (2000)
DOI: 10.1191/096032700666836486


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