A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital

Abstract

Background: Frostbite is a common yet challenging injury to both diagnose and treat. McCauley's frostbite treatment protocol consists of 12 treatments that might well represent the standard of care. However, its effectiveness in preventing operative intervention has yet to be examined. Our objectives were to characterize frostbite injuries in Eastern Ontario, identify risk factors for deep injuries, and assess the protocol's efficacy in preventing operative outcomes. Methods: This cohort study examined patients with frostbite over ten years at a tertiary care hospital. Demographics and predisposing factors were recorded. Frostbite severity was categorized into superficial or deep. Treatments were recorded, including adherence to protocol and operative outcome. Results: Of the 265 frostbite patients identified, deep frostbite accounted for 56 (21.1%, 95% CI: 16.2-26.1%), of whom 20 (35.7%) had an operative outcome. Amputation occurred in 16 (28.6%) of deep injuries and debridement in 5 (8.9%). Risk factors for deep frostbite were older age (p = 0.002), smoking (p <0.001), male sex (p = 0.056) and alcohol abuse (p = 0.056). None of the patients with deep frostbite had all 12 treatments performed. Adherence to protocol ranged from 0.0% to 48.2% per treatment. The rate of operative intervention was 7.7% in patients with deep frostbite who did not have any McCauley's frostbite treatments and ranged from 0.0% to 100.0% per treatment in those who did receive treatments. Conclusions: The frostbite protocol was not regularly followed and therefore its efficacy in preventing operative intervention could not be determined. Further, none of the individual treatments in the protocol were associated with preventing operative intervention. We recommend that future research focus on identifying effective individual treatments.

Predisposing factors for frostbite - a ten-year retrospective study

“…Although this grouping seems intuitively correct, recent epidemiological studies have classified adults aged 30-49 years as the group at high risk of frostbite [18,24]. Moreover, past research has indicated that males are more frequently affected by cold-induced injuries than females, which is also consistent with our results [10,12,18,25,26]. The incidents reported in these studies are strongly related to these findings, as males constituted a vast majority of subjects.…”

“…This is in line with the results obtained by Conway et al [20], who noted that 27% of all frostbite victims in Alaska were alcoholics. Likewise, Fabian et al [12] in a 10-year long retrospective study reported that among the top risk factors for frostbite was alcohol abuse.…”

“…Although individual, socioeconomic, and environmental factors are considered fundamental determinants of health in general, factors predisposing to frostbite are less wellknown than previously thought [18]. Therefore, detailed studies are necessary to determine the predisposing factors influencing frostbite [10,12,18]. Therefore, we examined the associations among these factors and frostbite for patients in Belgrade, Serbia.…”

“…Predisposing factors for frostbite have been described in many large epidemiological studies conducted worldwide [10,11,12]. Studies conducted in United States, Norway, and Finland have linked frostbite to homelessness, improper clothing, atherosclerosis, wound infection, diabetes, smoking, and fatigue [13][14][15][16].…”

“…Studies conducted in United States, Norway, and Finland have linked frostbite to homelessness, improper clothing, atherosclerosis, wound infection, diabetes, smoking, and fatigue [13][14][15][16]. In Canada it was reported additional predisposing factors related to frostbite, such as alcohol consumption, smoking, psychiatric illness, vehicular failure, drug misuse, and homosexual intercourse [12,17]. Recent studies have also provided evidence that prevalence is the highest between the ages of 30 and 49 [18,19].…”