Moderate or severe scorpion sting: identification of risk factors

To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification.

Method:

Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable.

Results:

A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services.

Conclusion:

The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.

DESCRIPTORS
Scorpion Stings; Risk Factors; Nursing

Epidemiological variables	N	%
Age
0 to 14 years	106	14.08
15 years or more	647	85.92
Sex
Female	421	55.84
Male	333	44.16
Accident location
Urban	658	87.27
Rural	80	10.61
Not specified	16	2.12
Type of accident
Non-occupational	604	80.11
Occupational	149	19.76
Not specified	1	0.13
Type of scorpion
Tityus serrulatus	142	18.83
Tityus bahiensis	50	6.63
Not identified	562	75.54
Classification Ministry of Health
Light	710	94.16
Moderate	36	4.77
Severe	8	1.06
Khattabi Classification
Dry sting	20	2.65
Class I	690	91.51
Class II	33	4.38
Class III	10	1.33
Fatal	1	0.13

Variables	Ministry of Health Classification		p-value
Variables	Mild n (%)	Moderate/Severe n (%)	p-value
Age
0–14 years	76 (10.72)	30 (68.18)	<0.0001^* * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
15 years or more	633 (89.28)	14 (31.82)
Type of scorpion
Tityus bahiensis	49 (6.90)	1(2.27)	0.478^* * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
Tityus serrulatus	134 (18.87)	8 (18.18)
Not identified	527 (74.23)	35 (79.55)
Number of stings
Single sting	682 (96.06)	39 (88.64)	0.373^** * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
More than one sting	28 (3.94)	5 (11.36)
Primary care
CIATox	597 (84.08)	11 (25.00)	<0.0001^* * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
Previous care	113 (15.92)	33 (75.00)
Previous analgesia
No	620 (87.32)	23 (52.27)	<0.0001^* * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
Yes	90 (12.68)	21 (47.73)
Administration of AScVS
No	710 (100.00)	12 (27.27)	<0.0001^** * p-value obtained through the chi-square test; **p-value obtained using Fisher’s exact test. AScVC: anti-scorpion venom serum.
Yes	0 (0.00)	32 (72.73)

Independent variables	Prevalence ratio*	CI 95%		p-value
Independent variables	Prevalence ratio*	LL	UL	p-value
Model 1
Women	0.89	0.52	1.51	0.6610
Age ≤ 19 years	8.21	4.47	15.10	< 0.0001
Rural accident	1.28	0.73	2.24	0.3945
Occupational cause	1.13	0.35	3.62	0.8342
Previous treatment	8.76	4.72	16.25	< 0.0001
2 or more stings	2.07	0.85	5.06	0.1087
Model 2
Women	0.90	0.54	1.49	0.6684
Age ≤ 22 years	6.40	3.43	11.94	< 0.0001
Rural accident	1.52	0.87	2.67	0.1409
Occupational cause	0.85	0.27	2.69	0.7885
Previous treatment	8.83	4.79	16.26	< 0.0001
2 or more stings	1.98	0.89	4.40	0.0943

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Suzimar de Fatima Benato Fusco, Rua Tessália Vieira de Camargo, 126, Cidade Universitária, 13083-887 – Campinas, SP, Brazil sbenato@unicamp.br