Patient and treatment characteristics that predict symptom resolution and limb amputation in patients with frostbite

Vijay Menon; Lucas Richards; Carissa Walter; Peyton Ackerman; Kate Young; Lauren Clark; Yanming Li; Adam Alli; Aaron Rohr

doi:10.1016/j.burns.2025.107547

Patient and treatment characteristics that predict symptom resolution and limb amputation in patients with frostbite

Burns. 2025 May 19;51(6):107547. doi: 10.1016/j.burns.2025.107547. Online ahead of print.

Authors

Vijay Menon¹, Lucas Richards², Carissa Walter³, Peyton Ackerman⁴, Kate Young⁵, Lauren Clark⁵, Yanming Li⁵, Adam Alli⁴, Aaron Rohr⁴

Affiliations

¹ University of Missouri, School of Medicine, Kansas City, USA.
² University of Kansas Medical Center, School of Medicine, USA.
³ University of Kansas Medical Center, Department of Interventional Radiology, USA. Electronic address: cwalter2@kumc.edu.
⁴ University of Kansas Medical Center, Department of Interventional Radiology, USA.
⁵ University of Kansas School Medical Center, Department Biostatistics & Data Science, USA.

PMID: 40424671
DOI: 10.1016/j.burns.2025.107547

Abstract

Purpose: To describe imaging and treatment received by frostbite patients and determine characteristics that predict symptom resolution and limb amputation.

Materials and methods: This retrospective study included 174 adult patients with acute frostbite at a single institution from May 1, 2004, to August 31, 2019. Demographics, frostbite classification, symptoms present and imaging received at presentation, treatment received, and dates of symptom resolution, were collected.

Results: Patients most commonly received no imaging (60.3 %), followed by x-ray (28.7 %). The most common treatments were debridement (53.4 %), none (24.1 %), other (15.5 %), antibiotics (12.6 %), and tPA (8.0 %). Of 17 who had a limb amputated, the number of affected extremities (p = 0.003), frostbite degree (p = 0.004), and baseline symptoms of abnormal skin color change (p = 0.028), absence of pulse (p = 0.021), swelling (p = 0.010), and necrosis/gangrene (p = 0.002) significantly increased the risk of limb amputation. tPA lowered the risk of limb amputation with an estimated hazard ratio of 0.193 (p = 0.003).

Discussion: Patients received a variety of treatments and imaging for frostbite. tPA was not often used in this study but could play a larger role in the treatment of frostbite since it was shown to lower the risk of limb amputation.

Keywords: Frostbite; Limb amputation; tPA.