{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T03:33:39Z","timestamp":1774668819038,"version":"3.50.1"},"update-to":[{"DOI":"10.1002\/14651858.cd009688.pub2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T00:00:00Z","timestamp":1685923200000}}],"reference-count":58,"publisher":"Wiley","issue":"6","content-domain":{"domain":["wiley.com","cochranelibrary.com"],"crossmark-restriction":true},"short-container-title":[],"DOI":"10.1002\/14651858.cd009688.pub3","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T08:01:46Z","timestamp":1686211306000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Interventions for the symptoms and signs resulting from jellyfish stings"],"prefix":"10.1002","volume":"2023","author":[{"given":"Richard G","family":"McGee","sequence":"additional","affiliation":[{"name":"The University of Newcastle Central Coast Clinical School; Gosford Hospital; Gosford Australia"},{"name":"Department of Paediatrics; Gosford Hospital; Gosford, NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela C","family":"Webster","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health; The University of Sydney; Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon R","family":"Lewis","sequence":"additional","affiliation":[{"name":"Bone and Joint Health, Blizard Institute; Queen Mary University of London; London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Welsford","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine; McMaster University; Hamilton Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,5]]},"reference":[{"key":"10.1002\/14651858.CD009688.pub3-BIB0001|cit1","first-page":"A22","article-title":"Randomised crossover trial comparing hot showers and ice packs in the treatment of Physalia envenomation","volume":"14","author":"Bowra","year":"2002","journal-title":"Emergency Medicine"},{"issue":"1","key":"10.1002\/14651858.CD009688.pub3-BIB0002|cit2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.wem.2015.10.008","article-title":"Efficacy of topical treatments for Chrysaora chinensis species: a human model in comparison with an in vitro model","volume":"27","author":"DeClerck","year":"2016","journal-title":"Wilderness and Environmental Medicine"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0003|cit3","unstructured":"Effective treatments for jellyfish stings Chrysaora chinensis clinicaltrials.gov\/ct2\/show\/NCT02015195"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0004|cit4","unstructured":"A randomised controlled trial of hot water (45C) immersion versus ice packs for Chironex fleckeri stings Chironex fleckeri www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=24&isReview=true"},{"issue":"6","key":"10.1002\/14651858.CD009688.pub3-BIB0005|cit5","doi-asserted-by":"crossref","first-page":"258","DOI":"10.5694\/mja16.00990","article-title":"Hot water immersion v icepacks for treating the pain of Chironex fleckeri stings: a randomised controlled trial","volume":"206","author":"Isbister","year":"2017","journal-title":"Medical Journal of Australia"},{"issue":"7","key":"10.1002\/14651858.CD009688.pub3-BIB0006|cit6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5694\/j.1326-5377.2006.tb00265.x","article-title":"A randomised controlled trial of hot water (45\u00b0C) immersion versus ice packs for pain relief in bluebottle stings","volume":"184","author":"Loten","year":"2006","journal-title":"Medical Journal of Australia"},{"issue":"5","key":"10.1002\/14651858.CD009688.pub3-BIB0007|cit7","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1742-6723.2012.01602.x","article-title":"Randomised trial of magnesium in the treatment of Irukandji syndrome","volume":"24","author":"McCullagh","year":"2012","journal-title":"Emergency Medicine Australasia"},{"issue":"7","key":"10.1002\/14651858.CD009688.pub3-BIB0008|cit8","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1053\/ajem.2002.35710","article-title":"A randomized paired comparison trial of cutaneous treatments for acute jellyfish (Carybdea alata) stings","volume":"20","author":"Nomura","year":"2002","journal-title":"American Journal of Emergency Medicine"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0009|cit9","first-page":"100","article-title":"Box jellyfish (Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs on their stings to swimmers at the beach: a randomized, placebo-controlled, clinical trial","volume":"60","author":"Thomas","year":"2001","journal-title":"Hawaii Medical Journal"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0010|cit10","first-page":"205","article-title":"Box jellyfish (Carybdea alata) in Waikiki: the analgesic effect of Sting-Aid, Adolph's meat tenderizer and fresh water on their stings: a double-blinded, randomized, placebo-controlled clinical trial","volume":"60","author":"Thomas","year":"2001","journal-title":"Hawaii Medical Journal"},{"issue":"7","key":"10.1002\/14651858.CD009688.pub3-BIB0011|cit11","doi-asserted-by":"crossref","first-page":"394","DOI":"10.5694\/j.1326-5377.1980.tb131882.x","article-title":"Disarming the bluebottle: treatment of Physalia envenomation","volume":"2","author":"Turner","year":"1980","journal-title":"Medical Journal of Australia"},{"issue":"6","key":"10.1002\/14651858.CD009688.pub3-BIB0012|cit12","first-page":"401","article-title":"Hot water immersion for bluebottle stings","volume":"42","year":"2013","journal-title":"Australian Family Physician"},{"issue":"4","key":"10.1002\/14651858.CD009688.pub3-BIB0013|cit13","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.cbpc.2010.01.007","article-title":"Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts","volume":"151","author":"Birsa","year":"2010","journal-title":"Comparative Biochemistry and Physiology. Toxicology & Pharmacology : CBP"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0014|cit14","first-page":"522","article-title":"Hot water immersion for bluebottle stings","volume":"42","author":"Fenner","year":"2013","journal-title":"Australian Family Physician"},{"issue":"10","key":"10.1002\/14651858.CD009688.pub3-BIB0015|cit15","article-title":"FPIN's clinical inquiries: treatment of jellyfish envenomation","volume":"89","author":"Honeycutt","year":"2014","journal-title":"American Family Physician"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0016|cit16","doi-asserted-by":"crossref","first-page":"362, 362.e1","DOI":"10.5694\/mja17.00675","article-title":"Hot water immersion v icepacks for treating pain of chironex fleckeri stings: A randomised controlled trial","volume":"207","author":"Isbister","year":"2017","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0017|cit17","first-page":"512","article-title":"Hot water immersion treatment for lion's mane jellyfish stings in Scandinavia","volume":"54 (4)","author":"Knudsen","year":"2016","journal-title":"Clinical Toxicology"},{"issue":"6","key":"10.1002\/14651858.CD009688.pub3-BIB0018|cit18","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1111\/1742-6723.12675","article-title":"Clonidine to treat Irukandji syndrome","volume":"28","author":"Little","year":"2016","journal-title":"Emergency Medicine Australasia"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0019|cit19","doi-asserted-by":"crossref","first-page":"362, 362.e1","DOI":"10.5694\/mja17.00398","article-title":"Hot water immersion v icepacks for treating pain of chironex fleckeri stings: A randomised controlled trial","volume":"207","author":"Little","year":"2017","journal-title":"Medical Journal of Australia"},{"issue":"4","key":"10.1002\/14651858.CD009688.pub3-BIB0020|cit20","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.annemergmed.2014.09.009","article-title":"What is the most effective treatment for relieving the pain of a jellyfish sting?","volume":"65","author":"Ostermayer","year":"2015","journal-title":"Annals of Emergency Medicine"},{"issue":"4","key":"10.1002\/14651858.CD009688.pub3-BIB0021|cit21","first-page":"319","article-title":"Treatment of jellyfish stings","volume":"26","author":"Putze","year":"2014","journal-title":"Emergencias"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0022|cit22","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.toxicon.2015.10.019","article-title":"Modulation of jellyfish nematocyst discharges and management of human skin stings in Nemopilema nomurai and Carybdea mora","volume":"109","author":"Pyo","year":"2016","journal-title":"Toxicon"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0023|cit23","unstructured":"Efficiency of a jellyfish sting inhibitor sun lotion and protocols for jellyfish sting pain relief http:\/\/apps.who.int\/trialsearch\/Trial.aspx?TrialID=EUCTR2008-001519-39-NO"},{"issue":"3","key":"10.1002\/14651858.CD009688.pub3-BIB0024|cit24","doi-asserted-by":"crossref","first-page":"158","DOI":"10.2500\/aap.2020.41.200014","article-title":"Jellyfish anaphylaxis: a wide spectrum of sensitization routes","volume":"41","author":"Amato","year":"2020","journal-title":"Allergy and Asthma Proceedings"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0025|cit25","unstructured":"Australian Resuscitation Council Guideline 9.4.5 Envenomation - Jellyfish stings, July 2010 https:\/\/resus.org.au\/guidelines\/ (accessed October 2021)"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0026|cit26","unstructured":"First Aid for someone with a jellyfish sting www.redcross.org.au\/firstaid\/basics\/jellyfish\/"},{"issue":"6","key":"10.1002\/14651858.CD009688.pub3-BIB0027|cit27","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1067\/mem.2001.118012","article-title":"Clinically significant changes in pain along the visual analog scale","volume":"38","author":"Bird","year":"2001","journal-title":"Annals of emergency medicine"},{"issue":"2","key":"10.1002\/14651858.CD009688.pub3-BIB0028|cit28","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3390\/md11020523","article-title":"Jellyfish stings and their management: a review","volume":"11","author":"Cegolon","year":"2013","journal-title":"Marine Drugs"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0029|cit29","doi-asserted-by":"crossref","first-page":"411","DOI":"10.5694\/j.1326-5377.2003.tb05263.x","article-title":"Magnesium infusion to treat Irukandji syndrome","volume":"178","author":"Corkeron","year":"2003","journal-title":"Medical Journal of Australia"},{"issue":"14","key":"10.1002\/14651858.CD009688.pub3-BIB0030|cit30","doi-asserted-by":"crossref","first-page":"8430","DOI":"10.3390\/ijerph19148430","article-title":"Raising awareness on the clinical and forensic aspects of jellyfish stings: a worldwide increasing threat","volume":"19","author":"Cunha","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"11\/12","key":"10.1002\/14651858.CD009688.pub3-BIB0031|cit31","doi-asserted-by":"crossref","first-page":"631","DOI":"10.5694\/j.1326-5377.2005.tb00062.x","article-title":"Prospective study of Chironex fleckeri and other box jellyfish stings in the \"Top End\" of Australia's Northern Territory","volume":"183","author":"Currie","year":"2005","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0032|cit32","unstructured":"Deeks JJ Higgins JP Altman DG editor(s) on behalf of the Cochrane Statistical Methods Group Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.2.0 (updated June 2017), The Cochrane Collaboration, 2017 Available from training.cochrane.org\/handbook\/archive\/v5.2"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0033|cit33","unstructured":"EndNote X5 Thomson Reuters 2011"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0034|cit34","unstructured":"GRADEpro GDT McMaster University and Evidence Prime"},{"issue":"7651","key":"10.1002\/14651858.CD009688.pub3-BIB0035|cit35","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1136\/bmj.39490.551019.BE","article-title":"What is \"quality of evidence\" and why is it important to clinicians?","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"issue":"12","key":"10.1002\/14651858.CD009688.pub3-BIB0036|cit36","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jclinepi.2011.01.012","article-title":"GRADE guidelines 6. Rating the quality of evidence - imprecision","volume":"64","author":"Guyatt","year":"2011","journal-title":"Journal of Clinical Epidemiology"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0037|cit37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5694\/j.1326-5377.1980.tb134566.x","article-title":"Disarming the box-jellyfish: nematocyst inhibition in Chironex fleckeri","volume":"1","author":"Hartwick","year":"1980","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0038|cit38","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0039|cit39","unstructured":"Higgins JPT Altman DG Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017 Available from training.cochrane.org\/handbook\/archive\/v5.2"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0040|cit40","unstructured":"Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ Cochrane Handbook for Systematic Reviews of Interventions version 6.2\u00a0(updated February\u00a02021). Cochrane, 2021 Available from training.cochrane.org\/handbook\/archive\/v6.2"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0041|cit41","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5694\/j.1326-5377.2003.tb05041.x","article-title":"Severity of Irukandji syndrome and nematocyst identification from skin scrapings","volume":"178","author":"Huynh","year":"2003","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0042|cit42","unstructured":"Fenner P ILSF Policy Statement MPS. 5 - Envenomation International Life Saving Federation. Available from https:\/\/www.ilsf.org\/position-statements-3\/ (accessed October 2021)"},{"issue":"7","key":"10.1002\/14651858.CD009688.pub3-BIB0043|cit43","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3390\/md14070127","article-title":"To pee, or not to pee: a review on envenomation and treatment in European jellyfish species","volume":"14","author":"Montgomery","year":"2016","journal-title":"Marine Drugs"},{"issue":"11\/12","key":"10.1002\/14651858.CD009688.pub3-BIB0044|cit44","doi-asserted-by":"crossref","first-page":"652","DOI":"10.5694\/j.1326-5377.2001.tb143765.x","article-title":"Prospective study of jellyfish stings from tropical Australia, including the major box jellyfish Chironex fleckeri","volume":"175","author":"O'Reilly","year":"2001","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0045|cit45","doi-asserted-by":"crossref","first-page":"650","DOI":"10.5694\/j.1326-5377.2000.tb139373.x","article-title":"Pressure immobilisation bandages in first-aid treatment of jellyfish envenomation: current recommendations reconsidered","volume":"173","author":"Pereira","year":"2000","journal-title":"Medical Journal of Australia"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0046|cit46","unstructured":"Review Manager 5 (RevMan 5) The Cochrane Collaboration 2020"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0047|cit47","doi-asserted-by":"crossref","first-page":"e0272359","DOI":"10.1371\/journal.pone.0272359","article-title":"Environmental drivers of the occurrence and abundance of the Irukandji jellyfish (Carukia barnesi)","volume":"17","author":"Rowley","year":"2022","journal-title":"PLoS One"},{"issue":"8","key":"10.1002\/14651858.CD009688.pub3-BIB0048|cit48","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.3390\/toxins5081343","article-title":"Clinical marine toxicology: a European perspective for clinical toxicologists and poison centers","volume":"5","author":"Schmitt","year":"2013","journal-title":"Toxins (Basel)"},{"issue":"3","key":"10.1002\/14651858.CD009688.pub3-BIB0049|cit49","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S0196-0644(89)80421-4","article-title":"Fatal Portuguese man-o'-war (Physalia physalis) envenomation","volume":"18","author":"Stein","year":"1989","journal-title":"Annals of Emergency Medicine"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0050|cit50","volume-title":"Tintinalli's emergency medicine: a comprehensive study guide","author":"Tintinalli","year":"2020"},{"issue":"4","key":"10.1002\/14651858.CD009688.pub3-BIB0051|cit51","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.annemergmed.2012.04.010","article-title":"Evidence-based treatment of jellyfish stings in North America and Hawaii","volume":"60","author":"Ward","year":"2012","journal-title":"Annals of Emergency Medicine"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0052|cit52","first-page":"30","article-title":"An in-vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri","volume":"44","author":"Welfare","year":"2014","journal-title":"Diving and Hyperbaric Medicine"},{"issue":"4","key":"10.1002\/14651858.CD009688.pub3-BIB0053|cit53","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3390\/toxins8040097","article-title":"Heated debates: hot-water immersion or ice packs as first aid for Cnidarian envenomations?","volume":"8","author":"Wilcox","year":"2016","journal-title":"Toxins"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0054|cit54","volume-title":"Venomous and poisonous animals: a medical and biological handbook","author":"Williamson","year":"1996"},{"issue":"1","key":"10.1002\/14651858.CD009688.pub3-BIB0055|cit55","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.toxlet.2006.10.011","article-title":"The in vitro vascular effects of two chirodropid (Chironex fleckeri and Chiropsella bronzie) venoms","volume":"168","author":"Winter","year":"2007","journal-title":"Toxicology Letters"},{"issue":"3","key":"10.1002\/14651858.CD009688.pub3-BIB0056|cit56","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3390\/toxins9030105","article-title":"Cubozoan sting-site seawater rinse, scraping, and ice can increase venom load: upending current first aid recommendations","volume":"9","author":"Yanagihara","year":"2017","journal-title":"Toxins (Basel)"},{"issue":"3","key":"10.1002\/14651858.CD009688.pub3-BIB0057|cit57","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009688","article-title":"Interventions for the symptoms and signs resulting from jellyfish stings","author":"Li","year":"2012","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"10.1002\/14651858.CD009688.pub3-BIB0058|cit58","unstructured":"Interventions for the symptoms and signs resulting from jellyfish stings Cochrane Database of Systematic Reviews 2013 12 10.1002\/14651858.CD009688.pub2"}],"container-title":["Cochrane Database of Systematic Reviews"],"original-title":[],"language":"en","deposited":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T01:20:52Z","timestamp":1760404852000},"score":1,"resource":{"primary":{"URL":"http:\/\/doi.wiley.com\/10.1002\/14651858.CD009688.pub3"}},"subtitle":[],"editor":[{"name":"Cochrane Pain, Palliative and Supportive Care Group","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,6,5]]},"references-count":58,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"URL":"https:\/\/doi.org\/10.1002\/14651858.cd009688.pub3","relation":{},"ISSN":["1465-1858"],"issn-type":[{"value":"1465-1858","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,5]]}}}