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A Prospective Study of Stingray Injury and Envenomation Outcomes ABSTRACT Study objective: Stingray injuries result in thousands of emergency department visits annually. This study aimed to assess the complication rate and outcome of field treatment with hot water immersion. Methods: This was an on-site, prospective, observational study. Subjects were enrolled after having been stung by a stingray. A trained researcher obtained the following information: age, sex, health conditions and medications, and wound description. The efficacy of hot water immersion on pain was recorded. Patients were contacted on post-injury days 3, 7, and 14 for follow up. Results: 22 subjects were included. No obvious foreign bodies were observed in wounds. 10 subjects were treated with hot water immersion and povidone-iodine, 12 with hot water immersion alone. Ongoing symptoms or complications were noted at 3-day follow-up in 6 of 22 subjects (27.3%). One subject was diagnosed with cellulitis on post-sting day 8, and was treated with antibiotics. Ongoing symptoms or complications were reported more commonly in patients treated with hot water and povidone-iodine compared with those treated with hot water alone (p=0.056). There was a significant difference in wound size between those with and without ongoing symptoms at 3-day follow-up (p=0.0102). No wounds less than 1 cm developed any complications. Average duration of water immersion was 73.6 minutes (range 35-145 minutes). Mean pain score pre-treatment was 7.36 and post treatment was 2.18, with an average decrease of 5.18 (95% CI 4.22 – 6.15). Conclusion: Stingray injuries responded well to hot water immersion for pain control. Skin and soft tissue infection was diagnosed in 1 of 22 patients (4.55%). MANUSCRIPT Introduction Stingray injuries are implicated in thousands of emergency department visits annually in the United States, and are a major source of marine vertebrate-inflicted injury. A stingray’s tail possesses a serrated barb, and inadvertent human contact can cause it to whip its tail in defense, causing either a laceration or puncture wound to the victim. Penetration by this barb may result in a glandular secretion of venom. 1 Although most of these wounds result in a superficial tissue injury, there have been cases of wounds to certain anatomical areas that have led to complications such as arterial bleeding and