Factors associated with clinical severity in scorpion envenomation: a retrospective cross-sectional study in western Mexico between 2021 and 2025.

Introduction: Scorpion envenomation is a major public health concern in Mexico. Although Q9 most of the approximately 300,000 annual cases are resolved without complications, a subset present with moderate or severe manifestations, and around 35 deaths are reported each year. Identifying factors associated with greater clinical severity may improve clinical assessment and management. Our objective was to evaluate factors associated with clinical severity among scorpion envenomated patients in western Mexico. Methods: We conducted a retrospective crosssectional study of patients with scorpion envenomation treated at an emergency department in Mexico between 2021 and 2025. Multivariable regression models were used to examine the association of demographic characteristics, time to medical care, and prehospital practices with clinical severity. Results: Of 3,145 patients, 32% were mild, 60% moderate, and 8.2% severe. Delayed access to medical care was associated with higher odds of moderate or severe envenomation whereas older age and higher body weight were protective. Overall use of traditional remedies, mainly milk and garlic, was not associated with severity. However, oral garlic use was associated with increased odds of moderate or severe envenomation and more frequent upper pharyngeal symptoms. Discussion: These findings suggest that delays in care-seeking are consistently associated with more severe clinical presentation, whereas age-related factors may confer relative protection. The observed association with garlic use, likely reflects differences in care-seeking behavior or symptom perception rather than a direct biological effect. Interventions should prioritize reducing delays to medical evaluation and addressing prehospital practices linked to delayed presentation.