Time Matters in Severe Frostbite

Abstract

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.

Amputation Risk Factors in Severely Frostbitten Patients

“…The time to reach a clinical setting in order to receive advanced treatments (e.g., intravenous vasodilators or thrombolytic agents) was not considered in this study as none of the subjects received them. However, evidence suggests that reducing the time lapse before reaching an advanced medical post with possibilities of receiving more complex treatments such as thrombolytic factors and/or vasodilator iloprost in an adequate time frame may decrease the risk of amputation [12,23,24]. Nonetheless, more research is needed to evaluate the real impact of these therapies on frostbite sequelae.…”

“…Efforts have been made to establish risk factors for frostbite [9,10,11], as well as risk factors for amputation once the patient has reached in-hospital care [12,13]. However, little is known of the possibility of reducing amputation rates and improving the quality of injury management in the field once frostbite has already occurred.…”

Acute Management of Thermal Hand Burns in Adults

“…Thermal burns due to extreme cold were the subject of several articles, including the use of thrombolysis and a new scoring system, including an evaluation of the socioeconomic and cost and challenges of care provision for frostbite patients., 69,[241][242][243][244][245]…”

Iloprost for the treatment of frostbite: a scoping review

“…Studies have demonstrated a rapid loss of efficacy with delay of administration of thrombolytics. Nygaard et al showed that the time from rewarming to alteplase significantly impacted amputation rate, with each hour of delayed treatment leading to an additional 27% loss of tissue [ 15 ]. As per the aforementioned study, alteplase should ideally be initiated within 4 h of rewarming, with some benefits observed up to 12 h post-rewarming [ 15 ].…”