Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The aim of this study was to examine the salvage rate following severe frostbite injury. Frostbite patients from 2006 to 2014 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with imaging demonstrating a lack of blood flow in limbs/digits were included in the analysis (N = 73). The Hennepin Frostbite Score was used to quantify frostbite injury and salvage. This score provides a single value to assess each individual patient's salvage rate. The majority of patients with perfusion deficits were male (80%) with an average age of 42 years (range 11-83 years). Patients requiring amputation tended to be older (P = .002), have more tissue impacted by frostbite (P < .001), and experienced a longer time from rewarming to thrombolytic therapy (P = .001). A majority of patients (62%) received thrombolytic treatment. The percentage of patients requiring amputation was lower and the salvage rate was higher in patients treated with thrombolytics; however, the differences failed to reach statistical significance (P = .092 and P = .061, respectively). The rate of salvage decreases as the time from rewarming to thrombolytic therapy increases. Regression analysis demonstrates an additional 26.8% salvage loss with each hour of delayed treatment (P = .006). When the amount of tissue at risk for amputation is included in the model, each hour delay in thrombolytic treatment results in a 28.1% decrease in salvage (P = .011). This study demonstrates a significant decrease in limb/digit salvage with each hour of delayed administration of thrombolytics in patients with severe frostbite.
For those at risk for cold-related injury, frostbite contributes significant morbidity through loss of limbs and digits. Frostbite injury generally affects distal extremities first and spreads proximally as the time of exposure increases. The Hennepin score is a tool to quantify injury and tissue loss of frostbite injury, similar to TBSA calculators in burn patients. Application of the Hennepin score allows for a clear picture of the effect of treatment through calculation of a salvage rate. The authors found high reliability between raters using the Hennepin score worksheet, suggesting consistency with applying the score to frostbite injury and outcomes (intraclass correlation, 0.93; confidence interval, 0.88-0.97). The Hennepin score allows for a standard means to accurately measure injury and outcomes, which will aid in the study of treatment outcomes of frostbite injuries.
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