Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Department of Anaesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt.
Am J Trop Med Hyg. 2019 Oct;101(4):941-945. doi: 10.4269/ajtmh.19-0319.
This study aimed to identify the clinical and laboratory manifestations that affect outcome of scorpion envenomation in children. It included 154 children admitted with scorpion sting envenomation over a period of 2 years. The epidemiological, clinical, and laboratory findings of patients were recorded, and grading of severity was performed based on local and systemic involvement. Organ failure was determined according to diagnostic criterion of multiple organ dysfunction syndrome, and severity of illness was assessed by the Pediatric Risk of Mortality (PRISM III) score. Of studied children, 58.4% were males and 41.6% were females. Children aged > 5 years suffered more scorpion stings (79.9%) than others did. The place of residence was rural more than urban, outdoor stings more than indoors, nocturnal more than diurnal, and most stings were on the exposed areas of the limbs. Based on clinical evaluation, 37.7% of patients were classified as class I severity followed by class II (48.7%) and class III (13.6%). Among studied cases, 21 deaths (13.6%) were registered; all of them belonged to class III severity. Mortality was significantly higher in children with agitation, coma, convulsions, arrhythmia, heart failure, pulmonary edema, and priapism. There were significantly higher values of leukocytes, platelets, creatinine, liver enzymes, glucose, and creatine phosphokinase in non-survivors than in survivors. The presence of organ failure was associated with mortality. In addition, the need for mechanical ventilation and inotropic support were at increased risk of mortality. Moreover, a significant association was found between PRISM score and the number of failed organs with fatal outcome.
本研究旨在确定影响儿童蝎子螫伤预后的临床和实验室表现。它包括 2 年内收治的 154 名蝎子螫伤患儿。记录了患者的流行病学、临床和实验室发现，并根据局部和全身受累情况进行严重程度分级。根据多器官功能障碍综合征的诊断标准确定器官衰竭，根据儿科死亡率风险评分 (PRISM III) 评估疾病严重程度。在所研究的儿童中，58.4%为男性，41.6%为女性。> 5 岁的儿童比其他儿童遭受更多的蝎子螫伤（79.9%）。居住地点为农村多于城市，户外螫伤多于室内，夜间多于白天，大多数螫伤发生在四肢暴露部位。根据临床评估，37.7%的患者被归类为 I 级严重程度，其次是 II 级（48.7%）和 III 级（13.6%）。在所研究的病例中，有 21 例死亡（13.6%）；他们都属于 III 级严重程度。在有激动、昏迷、抽搐、心律失常、心力衰竭、肺水肿和阳萎的儿童中，死亡率明显更高。白细胞、血小板、肌酐、肝酶、葡萄糖和肌酸磷酸激酶在非幸存者中的值明显高于幸存者。器官衰竭的存在与死亡率相关。此外，需要机械通气和正性肌力支持与死亡率增加相关。此外，PRISM 评分与失败器官数量之间存在显著相关性，与致命结局相关。
