Severity of scorpion envenomation in Saudi Arabia: A systematic review

Over the course of five years, 72,168 scorpion stings were recorded in Saudi Arabia. Though a number of articles have been published on scorpion stings in the country, no review studies have sought to determine the severity of scorpion envenomation using a standardized scale. The purpose of this systematic review is, thus, to explore the signs and symptoms of scorpion envenomation victims in Saudi Arabia and classify them using the Abroug's severity scale. This review identified 49 articles published between January 1953 and September 2024 on scorpion sting incidents in Saudi Arabia. Out of this total, 26 (53.1 %) articles met the systematic review criteria. The selected articles were reviewed by an emergency physician, a pediatrician, an assistant professor, and a consultant in toxicology, knowing that all examined articles were published in peer reviewed journals indexed in PubMed, EMBASE, Scopus, Web of science and CINAHL. Preset keywords and medical subject headings (MeSH terms) were used for the review. Three reviewed studies reported that 20-52 % of scorpion victims are asymptomatic. Other studies confirmed that Class I local manifestations, such as pain, erythema, swelling, and burning are present in the majority of scorpion sting victims (47.4-100 %). Class II systemic symptoms, such as hypertension, tachycardia, restlessness, cold extremities, gastrointestinal abnormalities and priapism, were reported in 15 studies, while bleeding was recorded in 2 patients in the same study. More complicated Class III cases manifested neurological deteriorations (seizures, neurotoxicity and unconsciousness), pulmonary edema, and pulmonary/cardiac arrest. Jointly, the studies revealed that a total of 16,745 scorpion sting victims were admitted and hospitalized for more than 24 h, and hospital stay duration varied, for all patients, between 3 h and 4 weeks. Around 1371 cases in six studies refused treatment and were discharged against medical advice. Fifteen victims across ten studies died from the scorpion stings. Children and patients with pre-existing clinical conditions generally reported more severe signs and symptoms. Study findings showed that practitioners should be aware of the early warning signs of pulmonary edema, cardiac toxicity and myocarditis, which are not uncommon post scorpion envenomation. Practitioners should also take into consideration that electrolyte imbalances might occur, but they do not usually pose serious clinical problems. Hemorrhages might happen, but they are mostly treatable. In conclusion, it is advised that practitioners utilize the standardized Abroug's classification for grading signs and symptoms of scorpion stings.