Pediatric frostbite: A 10-year single-center retrospective study

Objective: To describe frostbite (freezing cold injured tissue) in children and intrinsic (psychological and behavioral) and extrinsic (meteorological and safety hazard) factors related to the injury. Methods: Retrospective chart review of children <18 years old referred to a regional pediatric hospital for frostbite, to determine the demographics, environment, and risk factors related to injuries. Results: 47 patients met the inclusion criteria. Median age was 15 years (IQR 12-16). All injuries occurred between November and March. 49% were admitted to the hospital and frostbite was associated with use of alcohol (53%), cigarettes (34%), marijuana (23%), and symptoms of depression (with and without suicidal ideation) (32%). Frostbite injury treated with conservative wound management presented at <-6 degrees C and injury that underwent surgical procedures occurred at temperatures <= -23 degrees C (p= 0.001). Longer exposure duration also significantly increased the likelihood of a surgical procedure (p <0.001). Intoxication and lack of supervision were two common factors, with lack of supervision at time of injury most common among patients 0-12 years (64%), and intoxication most common among patients ages 13-17 (61%). Conclusion: Frostbite injuries in children begins at temperatures <-6 degrees C; with risk of tissue loss increasing at temperatures below -23 degrees C. Lack of supervision and intoxication are major risk factors for frostbite in children. Two-thirds of younger children were unsupervised, whereas intoxication was frequently related to frostbite in adolescents. Both of these factors can be addressed through an education-based prevention program. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.