Little, Mark (2017) Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial. Medical Journal of Australia, 207 (8). 362.

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Abstract

[Extract] I congratulate Isbister and colleagues for performing a first aid randomised controlled trial on box jelly fish stings (a rarity in toxinology). The result is at variance with other studies on this topic (although they mainly involved North American jelly fish stings).

I agree with the authors and the accompanying editorial that the major weakness in the study was the up to 4-hour delay for treatment with hot water. Unlike the earlier bluebottle stings first aid study performed on the beach, this study is performed in the emergency department of the Royal Darwin Hospital, when the pain severity was lessening. Pain severity was the primary study outcome: 25% of the study group had pain scores of less than 26 (hot water) or 20 (ice), which is minimal pain. Only 10% of the study group received opioid analgesia, compared with the results obtained by Currie and Jacups in a 14-year prospective observational study of box jelly fish stings in Darwin, where 48% of patients received analgesia, including 30% of patients receiving narcotic analgesia.

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