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Systematic Reviews
Published in: Systematic Reviews 1/2017

Open Access 01-12-2017 | Research

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

Authors: Chaturaka Rodrigo, Ariaranee Gnanathasan

Published in: Systematic Reviews | Issue 1/2017

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Abstract

Background

Scorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting management.

Methods

We searched PubMed, EMBASE, Scopus, Web of Science and CINAHL and included controlled prospective clinical trials (randomized or non-randomized). The following interventions were assessed: adults and children with scorpion stings treated with (a) steroids vs. placebo, (b) different methods of pain relief, (c) antivenom vs. supportive treatment, (d) prazosin vs. supportive treatment, (e) antivenom vs. prazosin and (f) antivenom plus prazosin vs. prazosin alone. When trials had comparative outcomes, they were combined in a meta-analysis. Data was analysed with Review Manager 5. Dichotomous data were compared with relative risk (RR), and continuous data were compared with mean differences using a fixed effect model. There is no PROSPERO registration number for this study.

Results

Antivenom against Centruroides sp. are effective in reversing the clinical syndrome faster than no antivenom treatment in children (RR, 0.02; 95% CI, 0.01 to 0.06; 322 participants; three trials). Antivenom (against Mesobuthus tamulus) and prazosin combination is better than prazosin alone for faster resolution of symptoms (mean difference, −12.59 h; 95% CI, −14.01 to −11.17; 173 participants; three trials).

Conclusions

The polyvalent antivenom against Centruroides sp. in USA/Mexico and the monovalent antivenom against M. tamulus in India are effective for rapid resolution of symptoms. Prazosin is useful as an add-on therapy for M. tamulus stings.
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Literature
1.
2.
Quintero-Hernandez V, Jimenez-Vargas JM, Gurrola GB, Valdivia HH, Possani LD. Scorpion venom components that affect ion-channels function. Toxicon. 2013;76:328–42.CrossRefPubMedPubMedCentral
3.
Abroug F, Nouira S, Haguiga H, Elatrous S, Belghith M, Boujdaria R, Touzi N, Bouchoucha S. High-dose hydrocortisone hemisuccinate in scorpion envenomation. Ann Emerg Med. 1997;30(1):23–7.CrossRefPubMed
4.
Chippaux JP, Goyffon M. Epidemiology of scorpionism: a global appraisal. Acta Trop. 2008;107(2):71–9.CrossRefPubMed
5.
Abroug F, Ouanes-Besbes L, Ouanes I, Dachraoui F, Hassen MF, Haguiga H, Elatrous S, Brun-Buisson C. Meta-analysis of controlled studies on immunotherapy in severe scorpion envenomation. Emerg Med J. 2011;28(11):963–9.CrossRefPubMed
6.
Foex BA. Meta-analysis of controlled studies on immunotherapy in severe scorpion envenomation: a commentary. Emerg Med J. 2011;28(11):915–6.CrossRefPubMed
7.
The Nordic Cochrane Centre. Review manager [computer program]. 51st ed. Copenhagen: The Cochrane Collaboration; 2011.
8.
Greenland S. Quality scores are useless and potentially misleading. Am J Epidemiol. 1994;140(3):300–1.CrossRef
9.
10.
Aksel G, Guler S, Dogan N, Corbacioglu S. A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings. Hum Exp Toxicol. 2014;34(6):662–7.CrossRefPubMed
11.
Bawaskar HS, Bawaskar PH. Prazosin in management of cardiovascular manifestations of scorpion sting. Lancet. 1986;1(8479):510–1.CrossRefPubMed
12.
Bawaskar HS, Bawaskar PH. Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting. Ann Trop Med Parasitol. 1987;81(6):719–23.CrossRefPubMed
13.
Gupta V. Prazosin: a pharmacological antidote for scorpion envenomation. J Trop Pediatr. 2006;52(2):150–1.CrossRefPubMed
14.
Gupta BD, Parakh M, Purohit A. Management of scorpion sting: prazosin or dobutamine. J Trop Pediatr. 2010;56(2):115–8.CrossRefPubMed
15.
Abroug F, ElAtrous S, Nouira S, Haguiga H, Touzi N, Bouchoucha S. Serotherapy in scorpion envenomation: a randomised controlled trial. Lancet. 1999;354(9182):906–9.CrossRefPubMed
16.
Belghith M, Boussarsar M, Haguiga H, Besbes L, Elatrous S, Touzi N, Boujdaria R, Bchir A, Nouira S, Bouchoucha S, et al. Efficacy of serotherapy in scorpion sting: a matched-pair study. J Toxicol Clin Toxicol. 1999;37(1):51–7.CrossRefPubMed
17.
Sofer S, Shahak E, Gueron M. Scorpion envenomation and antivenom therapy. J Pediatr. 1994;124(6):973–8.CrossRefPubMed
18.
LoVecchio F, McBride C. Scorpion envenomations in young children in central Arizona. J Toxicol Clin Toxicol. 2003;41(7):937–40.CrossRefPubMed
19.
Boyer LV, Theodorou AA, Chase PB, Osnaya N, Berg M, Mallie J, Carbajal Y, de Jesus-Hernandez T, Olvera F, Alagon A. Effectiveness of Centruroides scorpion antivenom compared to historical controls. Toxicon. 2013;76:377–85.CrossRefPubMed
20.
Boyer LV, Theodorou AA, Berg RA, Mallie J, Arizona Envenomation I, Chavez-Mendez A, Garcia-Ubbelohde W, Hardiman S, Alagon A. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med. 2009;360(20):2090–8.CrossRefPubMed
21.
Bond GR. Antivenin administration for Centruroides scorpion sting: risks and benefits. Ann Emerg Med. 1992;21(7):788–91.CrossRefPubMed
22.
Natu VS, Kamerkar SB, Geeta K, Vidya K, Natu V, Sane S, Kushte R, Thatte S, Uchil DA, Rege NN, et al. Efficacy of anti-scorpion venom serum over prazosin in the management of severe scorpion envenomation. J Postgrad Med. 2010;56(4):275–80.CrossRefPubMed
23.
Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial. BMJ. 2011;342:c7136.CrossRefPubMedPubMedCentral
24.
Pandi K, Krishnamurthy S, Srinivasaraghavan R, Mahadevan S. Efficacy of scorpion antivenom plus prazosin versus prazosin alone for Mesobuthus tamulus scorpion sting envenomation in children: a randomised controlled trial. Arch Dis Child. 2014;99(6):575–80.CrossRefPubMed
25.
Bawaskar HS, Bawaskar PH. Utility of scorpion antivenin vs prazosin in the management of severe Mesobuthus tamulus (Indian red scorpion) envenoming at rural setting. J Assoc Physicians India. 2007;55:14–21.PubMed
26.
Metadata
Title
Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials
Authors
Chaturaka Rodrigo
Ariaranee Gnanathasan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2017
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-017-0469-8

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