Risk-Stratified Observation After Asymptomatic Paediatric Scorpion Envenomation May Safely Reduce Emergency Department Stay.

Aim: Current emergency department (ED) protocols in prone regions recommend monitoring for at least 4-6 h after paediatric scorpion envenomation. Since only limited evidence supports these guidelines, particularly for asymptomatic children, we evaluated routine ED observation in these patients.

Methods: We conducted a retrospective cohort study of southern Israeli children presenting with scorpion envenomation over a 15-month period using a validated envenomation severity score. The primary outcome was the development of delayed systemic symptoms requiring intervention. Children with Grade 1 scores (mild) were compared to those with Grade ≥ 2 scores (more severe).

Results: Of 287 patients, 238 (83%) presented with mild, and 49 (17%) with more severe envenomation. Less than 1% of mild patients developed delayed symptoms, all of which resolved with conservative management, and 99% were discharged. More severe patients were younger (median age 3.1 vs. 5.8 years), had a higher prevalence of allergy (31% vs. 13%), and 94% developed immediate symptoms requiring hospitalisation.

Conclusion: A risk-stratified approach taking into consideration age, time since envenomation, history of allergies, and symptom severity could safely reduce ED observation time since children with mild scorpion envenomation symptoms had a low risk of developing significant delayed complications.