Triage for Leiurus quinquestriatus scorpion envenomation in children - is routine ICU hospitalization necessary

(1) Leiurus quinquestriatus scorpion (LQS) envenomation is a common public health problem with a similar clinical presentation in the Middle East and worldwide: localized reactions occur in up to 97% of the victims. (2) LQS e nvenomation in children is potentially fatal since the severity of symptoms is weight-dependent, (3) A common policy is to hospitalize all children st ung by the LQS - regardless of clinical severity - in the pediatric intensi ve care unit (PICU). (4) Seventeen of 18 children treated at two Israeli me dical centers during an 8-year period developed mild to moderate clinical m anifestations (antivenin was given in the one severe case; all children sur vived): all 18 had been transferred to an ICU for surveillance. Since patie nt care in PICUs is far more costly and manpower-intense than in general em ergency rooms, we propose that a protocol of 6 h of surveillance in the eme rgency department is adequate and safe for most children who had been stung by LQS. Only children who develop systemic manifestations should be hospit alized and transferred to the intensive care unit. (5) Further prospective studies should be conducted to define specific subgroups that may benefit f rom these recommendations.