title: Severe scorpion envenomation among children: does hydrocortisone improve outcome? A case-control study.
abstract: 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.
  
  
  METHODS
  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 = 0.99) or presence of systemic inflammatory response syndrome (SIRS) (77 vs 70; p = 0.198). The proportion of patients with pulmonary edema was similar in the two groups (77 vs 71; 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Réanimation Médicale CHU, Hôpital Habib Bourguiba, Sfax, Tunisia. bahloulmab@yahoo.fr
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Rania
authors.initials: R
authors.lastname: Ammar
authors.forename: Rania
authors.initials: R
authors.lastname: Allala
authors.forename: Hassen
authors.initials: H
authors.lastname: Dammak
authors.forename: Olfa
authors.initials: O
authors.lastname: Turki
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000997:Antivenins / Q000627:therapeutic use*; D001733:Bites and Stings / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007223:Infant; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology; D007902:Length of Stay; D008297:Male; D012604:Scorpion Venoms / Q000506:poisoning*
chemical_list: D000893:Anti-Inflammatory Agents; D000997:Antivenins; D012604:Scorpion Venoms; C007133:hydrocortisone hemisuccinate; D006854:Hydrocortisone
keywords: Children; Glucocorticoids; ICU; Inflammation; Outcome; Scorpion envenomation