Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials.
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.
['Rodrigo|Chaturaka|C|0000-0003-2189-9177', 'Gnanathasan|Ariaranee|A|']
D058668:Adrenergic alpha-1 Receptor Antagonists D000818:Animals D000997:Antivenins D018849:Controlled Clinical Trials as Topic D004359:Drug Therapy, Combination D006801:Humans D010146:Pain D011224:Prazosin D065008:Scorpion Stings D012604:Scorpion Venoms D012605:Scorpions D013256:Steroids
Scorpion Systematic review Controlled clinical trial Antivenom Prazosin