Meta-analysis of controlled studies on immunotherapy in severe scorpion envenomation

Background Despite conflicting evidence, specific serotherapy is recommended for scorpion envenomation. Methods A meta-analysis of prospective or observational controlled studies, comparing intravenous scorpion antivenin (SAV) with control, was performed. Binary outcomes are reported as risk difference for clinical improvement and mortality rates. Analysis was performed both for the whole number of included studies and for two subgroups (set up according to the geographic origin of scorpions). Results Nine studies (four randomised controlled trials (RCTs), five observational) enrolling 687 patients were identified. Six dealt with Old World scorpions and three originated from Arizona. Overall, the rate of clinical improvement was similar in SAV treated and untreated patients (risk difference=0.22, 95% CI −0.35 to 0.79; p=0.45 for effect). Subgroup analysis showed favourable effects of SAV in the Arizona scorpion envenomation (risk difference=0.53; 95% CI 0.16 to 0.91; p Conclusions SAV should not be administered in Old World scorpion envenomation until its efficacy is established by an appropriately designed RCT. In the Arizona scorpion sting, SAV hastens the recovery process.