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

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.

Keywords: Antivenom; Controlled clinical trial; Prazosin; Scorpion; Systematic review.

Fig. 1

Flow diagram for selection of studies for the systematic review

Fig. 2

Risk of bias table for included studies (for meta-analyses)

Fig. 3

Forest plot for comparison of antivenom vs. placebo/supportive therapy for old world scorpion stings (outcome: symptom resolution at 4 h as an end point)

Fig. 4

Forest plot for comparison of antivenom vs. placebo/supportive therapy for new world scorpion stings (outcome: symptom resolution at 4 h as an end point)

Fig. 5

Forest plot for comparison of antivenom and prazosin vs. prazosin alone for M. tamulus stings (old world scorpions, outcome: mean duration for symptom resolution)