Citation

Endorf FW, Nygaard RM. J. Burn Care Res. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irab115

PMID

unavailable

Abstract

Severe frostbite injury can result in significant disability from amputation of limbs and digits which may be mitigated through prompt medical care. The reported rates of amputation vary widely between centers. Our aim is to describe the incidence and factors associated with amputation secondary to frostbite injury in the United States using a national sample of hospitalizations. Admissions for frostbite injury were identified in the National Inpatient Sample (2016-18). Factors associated with amputation were assessed by multivariable logistic regression and clustered by hospital. The overall incidence of frostbite injury in the U.S. is 0.83/100,000 people. Of the social factors associated with frostbite injury, homelessness and Black race were independently associated with a higher likelihood of amputation at the primary admission. Diagnosis of cellulitis was a predictor of amputation. Homeless frostbite patients more frequently discharged AMA and were less likely to discharge with supportive medical care, despite having a higher rate of more severe injury. Disability from amputation following frostbite injury impacts at least 20% of frostbite injured patients and disproportionally impacts the homeless population. Further study is needed to ascertain the decision-making that leads to early amputation following frostbite injury, especially in the homeless and Black population. Outreach and education efforts should be initiated to promote salvage of functional limb length following frostbite injury.

Language: en

Keywords

amputation; cold injury; disparities; frostbite; homeless