Use of point-of-care ultrasound to assess the severity of scorpion stings in hospitalized patients

Abstract

Introduction

Scorpionism is a public health problem, especially in tropical regions. In Brazil, the prevalence of envenomation by scorpions is high, and the average national lethality is around 0.16 percent. The Tityus serrulatus scorpion is the primary species of medical importance. However, objective tools to predict and define the severity of these envenomations are lacking.

Materials and methods

This was an observational study conducted among patients aged 0–19 years with scorpionism. Patients were admitted to a reference hospital between December 2020 and May 2022. Point-of-care ultrasound was performed within 24 hours of the scorpion sting.

Results

Forty-nine patients were included, with a median age of 3.6 (interquartile range 2.3–5.3) years and a predominance of females (51 percent). Fifteen patients (30.6 percent) presented major life-threatening signs, 32 (65.3 percent) minor systemic manifestations, and two (4.1 percent) only local manifestations. Left ventricular dysfunction was identified in 13 patients (26.5 percent). Ten patients (20.4 percent) presented pattern B (visualization of three or more B lines in the evaluated quadrant) in at least one lung window. The sensitivity and specificity of cardiac and pulmonary ultrasound to identify the most severely ill patients were 86 percent and 94 percent, respectively.

Discussion

The changes found on point-of-care ultrasound were associated with life-threatening signs. All patients with class III envenomation were referred to the intensive care unit, showing the importance of early identification of this subgroup. The main limitations were the small sample size and the fact that admission to intensive care was not based on systematic criteria.

Conclusions

Point-of-care ultrasound is able to identify early signs of pulmonary congestion and heart failure in scorpionism. It can be useful for the objective selection of patients who are at a higher risk of complications and death and who require intensive support; it may also be valuable for periodic reassessments. Point-of-care ultrasound is a valuable tool for identifying and monitoring severe cases of scorpionism.

Keywords:

• Scorpion sting
• Tityus serrulatus
• echocardiography
• bedside ultrasound
• heart failure
• myocarditis

Acknowledgements

We are grateful to the healthcare, laboratory, echocardiographers, and administrative teams of the Toxicology Department and to the team of Echocardiographers, especially Dr. Braulio Muzzi Ribeiro de Oliveira and Dr. Maria Cristina Costa de Almeida and Hospital das Clínicas from UFMG, who contributed to this study in different ways.

Author contributions

Juliana Sartorelo Almeida: conception and design of the study, analysis and interpretation of data, acquisition of data. Vandack Nobre: conception and design of the study, drafting the article, final approval of the version to be submitted; Cecilia Gomez Ravetti: conception and design of the study, analysis and interpretation of data, final approval of the version to be submitted; Marcus Vinícius de Melo Andrade: analysis and interpretation of data, final approval of the version to be submitted; Paula Frizera Vassallo: analysis and interpretation of data, final approval of the version to be submitted; Adebal de Andrade Filho: conception and design of the study, final approval of the version to be submitted; Rafael Silva e Castro: analysis and interpretation of data, acquisition of data; Pedro Pires Costa Pimenta: acquisition of data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Access to data collected in the research through the Research Electronic Data Capture platform can be obtained upon request to the authors.

Additional information

Funding

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico under Grant Number 406821/2021-6 (CNPq/MCTI/FNDCT N° 18/2021 – Faixa A – Grupos emergentes).