Severe scorpion envenomation among children: Does hydrocortisone improve outcome? A case-control study

Background: To analyse the efficacy and safety of systemic infusion of hydrocortisone hemisuccinate in children admitted to the intensive care unit with severe scorpion envenomation, we assessed the impact on mortality and length of hospital stay. Method: We conducted a pair-wise, case-control study with 1:1 matching, reviewing records over a 13-year period (1990-2002) for the intensive care unit (ICU) of the Habib Bourguiba University Hospital, Sfax, Tunisia. A total of 184 children were included in the study (92 cases and 92 controls); cases received hydrocortisone hemisuccinate during hospitalization and controls received no steroids. Patients were matched according to age (±2 years), severity factors at admission (pulmonary edema and grades of severity of scorpion envenomation) and scorpion antivenom administration. Results: Cases and controls did not differ significantly in age (4.9±5.5 years vs 6.2±3.8 years; p.0.05), mean temperature on admission (37.2±1.2 vs 37.2±1.06; p 1/4 0.99) or presence otion of patients with pulmonary edema was similar in the two groups (77 vs 7f systemic inflammatory response syndrome (SIRS) (77 vs 70; p 1/4 0.198). The propor1; p.0.05), and in each group 46 patients (50%) received scorpion antivenom (p.0.05). The use of mechanical ventilation, ICU length of stay and ICU mortality was not significantly different between the studied groups. Conclusion: We detected no significant difference between patients receiving steroids and steroid-free patients in terms of mortality and ICU length of stay. The hydrocortisone hemisuccinate regimen described here had a limited effect in critically ill envenomated children and, therefore, we suggest that it should not be recommended. © Royal Society of Tropical Medicine and Hygiene 2013. All rights reserved.