Clinical Severity in Scorpion Envenomation: Home Remedies, Delay to Medical Care, and Antivenom Dosing Strategies in an Emergency Department

NCT07408947 — Completed, 3145 participants, University of Guadalajara

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Clinical Severity in Scorpion Envenomation: Home Remedies, Delay to Medical Care, and Antivenom Dosing Strategies in an Emergency Department in Jalisco, Mexico

Registry	NCT07408947
Status	Completed
Study type	Observational
Enrollment	3145 (Actual)
Sponsor	University of Guadalajara (Other)
Conditions	Scorpion Envenomation
Dates	start 2025-08-07, primary completion 2025-12-01, completion 2025-12-31, first posted 2026-02-13, last updated 2026-02-13
Locations	1 site in Mexico

-Summary

Scorpion stings are a common medical emergency in Mexico, particularly in the state of Jalisco. While antivenom is the standard treatment for scorpion envenomation, there is variability in how it is used, including differences in dosing strategies. In addition, many patients use home remedies before seeking medical care, which may delay treatment and influence the severity of symptoms.

This study is an observational, retrospective analysis of patients treated for scorpion envenomation in the emergency department of a public hospital in Jalisco, Mexico, between 2021 and 2023. Using information from medical records, the study examines the relationship between the use of home remedies, the time to receive medical care, clinical severity at presentation, and the antivenom dosing strategies used, including traditional and reduced-dose approaches.

The goal of this study is to better understand factors associated with clinical severity and antivenom use in real-world emergency care. The results may help inform future clinical decision-making, promote rational use of antivenom, and improve timely access to appropriate medical treatment for patients with scorpion envenomation.

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+Arms and interventions

Arm	Type	Interventions	Description
Reduced dose			This group includes patients diagnosed with scorpion envenomation who were managed using a reduced-dose antivenom strategy during routine emergency care. In this approach, antivenom (faboterápico) was administered primarily to patients with systemic manifestations of envenomation. The initial dose generally consisted of a single intravenous vial, with additional vials administered only if clinical symptoms persisted or progressed after reassessment. Patients who did not receive antivenom because they presented without systemic symptoms were also included in this group. This management strategy differs from the Mexican national Clinical Practice Guidelines, which recommend antivenom administration to all patients with scorpion envenomation, regardless of the presence or absence of systemic symptoms. All treatment decisions were made by the treating physicians as part of standard clinical care, without protocol-mandated interventions.
Traditional dose			This group includes patients diagnosed with scorpion envenomation who were managed according to the traditional antivenom dosing strategy recommended by the Mexican national Clinical Practice Guidelines. These guidelines advise administering antivenom (faboterápico) to all patients with scorpion envenomation, independent of whether systemic symptoms are present, with dosing adjusted based on patient age and clinical severity. Under this strategy, patients typically received one or more intravenous vials of antivenom as an initial dose, with additional doses administered at predefined intervals if symptoms persisted, in accordance with guideline-based algorithms. All treatments were provided as part of routine emergency care, and no interventions were assigned for research purposes. This group reflects standard-of-care antivenom use in Mexico during the study period.

+Outcome measures

Primary outcomes

Clinical resolution of symptoms within 3 hours [From emergency department admission to 3 hours after initial treatment.]: Proportion of patients with scorpion envenomation who achieved complete clinical resolution of signs and symptoms within three hours after initial medical management in the emergency department.

Secondary outcomes

Need for additional antivenom doses [From initial antivenom administration until emergency department discharge (up to 24 hours)]: Proportion of patients who required one or more additional doses of antivenom after the initial administration due to persistence or progression of clinical symptoms.
Total number of antivenom vials administered [From initial antivenom administration until emergency department discharge (up to 24 hours)]: Total number of antivenom (faboterápico) vials administered per patient during emergency department management.
Use of supportive medications [From initial antivenom administration until emergency department discharge (up to 24 hours)]: Use of additional supportive medications, including benzodiazepines, anticholinergics, opioids, antiemetics, or other agents, administered during emergency department management.

Other outcomes

Clinical severity at presentation [At emergency department triage (baseline)]: Clinical severity of scorpion envenomation at the time of emergency department presentation, classified according to national clinical criteria (mild, moderate, or severe), based on documented signs and symptoms
Use of home remedies prior to medical care [At emergency department triage (baseline)]: Proportion of patients who reported the use of home remedies (traditional treatments) prior to seeking medical care for scorpion envenomation, as documented in the medical record.
Delay to medical care [From time of scorpion sting to recorded emergency department triage time (baseline)]: Time elapsed between scorpion sting and arrival at the emergency department.

+Eligibility

Sex: All

Inclusion Criteria:

* Patients of any age with a clinical diagnosis of scorpion envenomation.
* Patients evaluated and treated in the emergency department of the participating hospital.
* Availability of medical records with sufficient clinical information to assess envenomation severity, time to medical care, and antivenom administration.

Exclusion Criteria:

* Patients with incomplete or missing medical records that do not allow determination of clinical severity or antivenom use.
* Patients transferred from another healthcare facility after having already received definitive treatment for scorpion envenomation.
* Patients with documented co-envenomation or alternative diagnoses that could confound clinical severity assessment.
* Patients who declined medical evaluation or left the emergency department before completion of initial assessment and management.

+Locations (1)

Facility	City	Country	Status
Centro Universitario de Ciencias de la Salud	Guadalajara, Jalisco	Mexico

+Investigators

Christian J Baños, PhD, Study director, University of Guadalajara