Pediatric scorpion envenomation in Tunisia: epidemiology, clinical features, therapeutic management and outcomes in a 14-year cohort study

Background Scorpion envenomation is a persistent public health concern in Tunisia, particularly in rural areas. Children are especially vulnerable due to low body weight and immature physiological systems. Methods We conducted a retrospective cohort study over a 14-year period (2011–2024) in the Pediatric Intensive Care Unit of Hedi Chaker University Hospital, Sfax, Tunisia. Children aged 0–14 years with confirmed scorpion envenomation were included. Epidemiological, clinical, biological, and outcome data were analyzed. Results Sixty-nine children were included, with a mean age of 4.6 years; two-thirds were under five years of age. Most cases occurred during summer and originated from rural areas. Systemic manifestations were present in 85.5% of patients. Moderate and severe envenomation were predominant, with 49.3% classified as Grade II and 39.1% as Grade III. Cardiac involvement was frequent, with elevated cardiac troponin observed in nearly half of cases and left ventricular dysfunction in more than one-third. Antivenom was administered in 88.4% of patients, and inotropic support was required in 25.9%. There were no fatalities; however, 18.5% of patients developed sequelae, mainly cardiac. Younger age, severe clinical presentation, seizures, respiratory distress, hyperglycemia, ventricular dysfunction, pulmonary edema, and delayed medical care (>2 hours) were significantly associated with adverse outcomes. Conclusion Pediatric scorpion envenomation often leads to systemic and cardiac complications. Early recognition and rapid management are critical to reducing morbidity.