Effectiveness of Sensitisation Programme on Prazosin Therapy for Scorpion Envenomation at Primary and Secondary Healthcare Level
Introduction: Scorpion envenomation is a life-threatening paediatric emergency. Prazosin-an alpha-1 blocker is the gold standard therapy for scorpion envenomation. Many children with scorpion envenomation were under-treated at Primary Healthcare (PHC) and Secondary Healthcare (SHC) level becaus...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Pvt. Ltd.
2022-06-01
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| Series: | Indian Journal of Neonatal Medicine and Research |
| Subjects: | |
| Online Access: | https://www.ijnmr.net/articles/PDF/2334/54874_CE[Ra1]_F[SH]_PF1(AG_SHU)_PFA(SHU)_PB(AG_SHU)_PN(SHU).pdf |
| Summary: | Introduction: Scorpion envenomation is a life-threatening
paediatric emergency. Prazosin-an alpha-1 blocker is the
gold standard therapy for scorpion envenomation. Many
children with scorpion envenomation were under-treated at
Primary Healthcare (PHC) and Secondary Healthcare (SHC)
level because of lack of awareness about prazosin therapy. If
Prazosin is started earlier at PHC and SHC level, complications
and mortality can be reduced.
Aim: To conduct sensitisation programme for PHC and SHC
doctors regarding the management of paediatric emergencies
including scorpion envenomation, and to evaluate the
effectiveness of sensitisation programme on prazosin therapy
for scorpion envenomation at PHC and SHC level.
Materials and Methods: This non concurrent clinical trial
consisted of training PHC and SHC doctors at the Department
of Paediatrics, Government Dharmapuri Medical College
Hospital, Tamil Nadu, India for a period of two years (January
2018-December 2019). After the training, children aged 1
month-12 years with features of scorpion envenomation
referred from PHC and SHC to this tertiary care centre, during
January 2021-September 2021 were evaluated. The data
regarding initiation of prazosin therapy at PHC and SHC level
and the clinical profile, complications and outcome at tertiary
care level were noted. The present study parameters were
compared with previous study on scorpion envenomation,
done before the sensitisation programme in the same centre,
and the data were compared.
Results: Training was given to 120 medical officers of PHC and
SHC. Sixty-two children, with scorpion envenomation referred
from PHC and SHC, were included in the study. Seven (10%)
children were brought to the tertiary care centre directly were
excluded. Prazosin therapy was initiated in 43 (69.3%) children
at PHC and SHC level before referral. Initiation of prazosin within
four hours of scorpion sting was done in 45 (72.6%). Common
symptoms were pain {42 (68%)}, diaphoresis {26 (42%)} and
salivation {25 (40%)}. Cold peripheries, myocarditis and pulmonary
oedema were noted in 24 (39%), 4 (6%) and 6 (10%) children,
respectively. Dobutamine and Non Invasive Ventilation (NIV) were
needed in 13 (21%) and 11 (18%) cases, respectively. When
compared to the observations pre-training, peripheral circulatory
failure (76% to 39%) (p=0.019), pulmonary oedema (27% to 10%)
(p=0.010), myocarditis (17% to 6%) (p=0.039), ionotrope support
(41% to 21%) (p=0.024), and NIV (39% to 18%) (p<0.003) were
significantly reduced. There was no mortality.
Conclusion: Following the sensitisation programme, initiation
of prazosin for scorpion envenomation at PHC and SHC
level significantly improved. Complications like myocarditis,
pulmonary oedema, need for inotropes and ventilator support
decreased significantly |
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| ISSN: | 2277-8527 2455-6890 |