Evaluation of scorpion stings: the poison center perspective

Scorpion venom causes excessive adrenergic discharge and cardiotoxicity. Publications on scorpion stings using mainly admission data, has led to the belief that most scorpion stings are severe and mandate an observation period of at least 12 h regardless of symptomatology. We to assessed the characteristics of scorpion sting victims with emphasis on severity and time to presentation by retrospective poison center chart review of 225 calls over 12-mo. Thirteen percent of patients were asymptomatic and 72% and 15% were mild or moderately to severely ill, respectively. The most frequent manifestations were pain (97.3%), cardiovascular signs (23.1%) and ECG changes (13.7%). Ninety-four percent of the patients presented within 6 h; 86% within 3 h. Ninety-two percent of moderate to severe patients, including those with moderate to severe cardiotoxicity, presented within 3 h; 100% within 6 h. Clinical severity of the stings was greater in females than in males. No association was found between degree of severity and time to presentation and age. Most scorpion stings in Israel (at least those occurring in the north and central regions) are mild. The majority of envenomated patients present for medical assistance within 3 h including all patients with moderate to severe cardiotoxicity. Because of severity of potential complications, that scorpion sting victims should be observed in the emergency department for 6 h from the time of sting and should be admitted if symptoms other than local pain develop. Reduction of unnecessary in-hospital observation time is expected to save public health money.