Table 3 Summary of studies that include frostbite-related amputation
Author(s), year, country | Main findings |
|---|---|
Antti-poikka et al., 1990, Finland | ▪ 9 patient cases were included in this retrospective case-series ▪ 7 patients required frostbite-related amputation due to alcohol intoxication, with 6 cases (66%) occurring in patients with histories of chronic alcohol abuse ▪ 2 patients had psychological disorder (schizophrenia) ▪ The major predisposing factor for frostbite in this population was acute and/or chronic alcohol consumption |
Boles et al., 2018, Canada | ▪ 47 patients ranging from 1 to 17 years old met the inclusion criteria for this retrospective case series. ▪ Two important factors related to frostbite injury were identified: lack of supervision and intoxication. ▪ Frequently documented risk activities included the use of alcohol (n = 25, 53%), cigarettes (n = 16, 34%), marijuana (n = 11, 23%), and symptoms of depression with or without suicidal ideations (n = 15, 32%). |
Brandstrom et al., 2014, Sweden | â–ª 244 patient cases were included in this retrospective case-series â–ª Alcohol consumption was an associated factor for frostbite injury â–ª Higher rates of frostbite occurred among males |
Carceller et al., 2019, Spain | ▪ 92 patient cases were included in this retrospective case-series ▪ There were no differences found in amputation risk regarding age, gender, smoking, or occupation among patients with frostbite injuries ▪ Time before rewarming and delay before receiving medical attention for the frostbite injury are both risk factors for amputation |
Cauchy et al., 2001, France | â–ª 70 patient cases were included in this retrospective case-series â–ª Two cases were related to alcohol intake or a psychiatric disorder â–ª It was found that in most cases, frostbite resulted from inadequate protection/ winter clothing (due to poor knowledge of the terrain, dehydration and/ or exhaustion) |
Detanac et al., 2022, Serbia | â–ª This study describes the case report of a 40-year-old black male in Serbia who walked for a long period of time in cold winter weather and twice left the hospital against medical advice. â–ª The occurrence of frostbite is more frequent in the homeless, people who abuse alcohol, and those with a psychiatric disorder |
Endorf et al., 2022a, USA | ▪ 148 people were included in this retrospective cohort study ▪ 40 people (18%) required amputation ▪ Substance and/or alcohol use independently predicted frostbite-related limb amputation ▪ Substance use disorders (Odds Ratio (OR): 3.19; 95%CI 1.15–8.81) and homelessness (OR: 5.40; 95%CI 1.53–19.09) were independent predictors of unplanned hospital re-admission |
Endorf and Nygaard, 2022b, USA | ▪ This retrospective cohort study included 42,810 people ▪ During non-elective primary admission, homelessness (OR: 1.81; 95%CI 1.31–2.49) was associated with frostbite-related limb amputation ▪ Although substance and alcohol use were prevalent within the population with frostbite injury, there was no association of these factors with an increase in amputation ▪ Surprisingly, psychiatric disorders (OR:0.64; 95%CI 0.43–0.94) were not associated with frostbite-related limb amputation |
Endorf and Nygaard 2021a, USA | â–ª This retrospective cohort study involved 1065 patients, 29% of whom sustained frostbite injuries that resulted in at least one amputation â–ª The social factors associated with frostbite injury were homelessness, psychiatric disorders, and mental or behavioural disorders resulting from substance use |
Endorf and Nygaard 2021b, USA | ▪ This retrospective cohort study included 1617 people ▪ Approximately 34.6% of the frostbite injuries were related to homelessness, 35.2% were related to a mental health diagnosis, and 80.9% were related to a substance and/or alcohol use diagnosis ▪ Significant factors associated with a higher risk of frostbite-related limb amputation include Black race (OR: 1.71; 95%CI 1.22–2.39), homelessness (OR: 1.62; 95%CI 1.20–2.20), and male gender. |
Fabian et al., 2017, Canada | ▪ 265 people were included in this retrospective cohort study ▪ Prevalent predisposing factors for frostbite injuries included inadequate clothing/footwear (32.1%), alcohol abuse (15.1%), and psychiatric illness (20.8%) ▪ Comparing patients with deep frostbite to those with superficial frostbite, smoking was more prevalent, and patients were older (p-value < 0.001) |
Hashmi et al., 1998, Pakistan | â–ª 1500 patient cases were included in this retrospective case-series â–ª Frostbite injuries to the feet were most prevalent (64%), with substandard or damaged footwear being a likely factor â–ª Patients with proper education were able to recognize early symptoms of frostbite and thus receive treatment faster, lessening the degree of injury |
Jovic et al., 2019, Serbia | â–ª 24 patient cases were included in this retrospective case-series â–ª Of the patients treated for frostbite, 58% were chronic alcohol consumers, 46% were long-term smokers, 33% suffered from psychiatric disorder, and 13% were homeless â–ª Most patients were male (88%) |
Kloeters et al., 2011, Germany | â–ª This case report details the case of a 19-year-old man involved in a car accident on an abandoned road in rural Germany, in which he fell unconscious during cold Winter temperatures â–ª The main suggestion of this report is that early initiation of rescue triage is paramount to ensure devastating injuries do not progress |
Koljonen et al., 2004, Finland | â–ª 42 patient cases were included in this retrospective case-series â–ª Of the 42 patients, 92 frostbite injuries were recorded â–ª 21 (50%) of the patients did not have surgery, 4 (10%) of the patients had minor surgery, and 17 (40%) had major surgery â–ª At the time of the frostbite injury, 25 (60%) of the patients were intoxicated by alcohol, 6 (14%) patients were homeless, and 14 (35%) had a mental illness |
Lindford et al., 2017, Finland | â–ª 20 patient cases treated for frosbite injury were included in this retrospective case-series â–ª 75% of the patient cases included societal risk factors, which included alcohol abuse, drug abuse, psychiatric illness, and smoking â–ª Of the societal risk factors, alcohol abuse was the most common and was found in 9 (45%) cases |
Lorentzen and Penninga, 2018, Greenland | ▪ 6 patient case reports were included in this study ▪ Of the total number of 6 patients, only 1 patient (16.7%) required amputation after a frostbite injury ▪ Most patients were males (83.3%) ▪ The cases illustrate some of the known risk factors for frostbite injuries, such as alcohol consumption and inadequate winter clothing (e.g. improper, ill-fitting or missing footwear, lack of gloves) |
Miller et al., 1980, Canada | â–ª 101 patient cases were included in this retrospective case series, with 66 receiving treatments for frostbite â–ª Amputation was required for one-third of patients treated in Saskatoon (representing 22 out of the 66 patients receiving treatment for frostbite). â–ª 59% of the frostbite injury cases included alcohol consumption as a contributing factor |
Nygaard et al., 2017, USA | â–ª 73 patient cases were included in this retrospective case series â–ª Most patients were males (80%) â–ª Factors associated with increased risk of frostbite injury included: homelessness (22%), alcohol abuse (69%), drug abuse (29%), and psychiatric illness (38%) |
Poole et al., 2021, Canada | â–ª 22 patient cases were included in this retrospective case series â–ª Alcohol use was a factor in 27% of cases, and was found to result in more severe frostbite injury |
Schellenberg et al., 2020, USA | ▪ 241 patient cases were included in this retrospective case-series ▪ 42% of patients with frostbite injury required ICU admission and 5% required amputation ▪ Patients admitted to the ICU had a greater need for amputation compared to those not admitted (9% vs. 4%, p-value = 0.04) ▪ Higher admission heart rate was an independent predictor of amputation (p-value = 0.013). |
Su et al., 2015, China | ▪ 568 patient cases were included in this retrospective case-series ▪ Patients who were admitted less than 1 day after sustaining frostbite injury had lower amputation rates than those whose admission time was greater than 1 day (p-value < 0.001) ▪ Amputation rates of patients who sustained frostbite injuries while consuming alcohol, experiencing psychiatric illness, and trauma (including traffic accidents) were higher than those injuries caused by improper protection and going astray (p-value < 0.01) |
Tavri et al., 2016, USA | â–ª 13 patient cases were included in this retrospective case-series â–ª Out of the 13 patients, 61.5% (8 patients) did not require amputation after frostbite injury, while 38.5% (5 patients) underwent amputation â–ª The characteristic predisposing risk factors of the patients included alcohol intoxication (76.9%), tobacco use (53.8%), homelessness (12.4%) |
Tran et al., 2022, USA | ▪ 54 patient cases were included in this retrospective case-series ▪ Of the 54 patients with frostbite, the characteristics are as follows: male (70%), substance use disorder (50%), and homeless (14%). ▪ There were no significant differences in the number of surgeries or amputations required among these groups of patients; however, patients with a positive substance use disorder screening, psychiatric disorders, active drug use, and homelessness were more likely to be readmitted for wound infections of gangrene progression. ▪ Psychiatric disorders were predictive of requiring additional surgeries (p-value = 0.02) and longer hospital stays (p-value = 0.046). |
Urschel, J., 1990, Canada | â–ª 79 patient cases were included in this retrospective case-series â–ª At the time of frostbite injury, it was found that 53% of the patients were under the influence of alcohol and 16% had a psychiatric illness â–ª A delay in seeking medical attention was found to be a factor associated with a poor outcome (amputation) |
Valnicek et al., 1993, Canada | â–ª 125 patient cases were included in this retrospective case-series â–ª Factors that did not show a statistical correlation with the need for amputation include history of alcohol intoxication, psychiatric illness, history of smoking, and age â–ª Significant factors associated with frostbite-related amputation included duration of cold exposure, lack of proper attire, location of injury in the wilderness, presence of wound infection, and delay in seeking treatment greater than 1Â day |
Wani et al., 2008, India | â–ª This case report presents the case of a 15-year-old female patient of low socioeconomic status who suffered frostbite to her feet while dwelling outdoors in the snow to collect water and timber for her household. â–ª She sustained fourth-degree frostbite injuries, which sequentially led to autoamputation of the distal portion of her feet over time. â–ª She had married in a low socio-economic stratum and recently shifted to the mountainous region. She had poor clothing and was unaware of the risk of frostbite injury and the means to protect herself, using snow to relieve her pain due to frostbite, thus further aggravating her injury. |
Zhang et al., 2022, China | â–ª 36 patient cases were included in this retrospective case-series â–ª 17 (47%) of the 36 cases required amputation â–ª Frostbite risk factors were as follows for the cases: alcohol consumption (47.2%), mental disorder (22.2%), homelessness (11.1%), less cold weather protection (8.3%), outdoor sports (8.3%), and drug use (2.8%). |
Zhao et al., 2020, China | ▪ 156 patient cases were included in this retrospective case-series ▪ There were no statistically significant differences regarding age or gender for patients who required amputation and those who did not ▪ Significant factors for an increased amputation rate were delayed presentation to the hospital and a longer time period before rewarming (p-value = 0.004) ▪ Smoking and alcohol abuse were identified as predisposing factors for frostbite-related amputation (p-value < 0.001) |