290 Pediatric Frostbite: A 10-year Single-center Retrospective Study

Frostbite is a thermal injury from frozen tissue. Literature is limited on children, a vulnerable population not in control of their environment. The objective is to describe frostbite in children referred to a regional pediatric hospital and intrinsic (psychological and behavioral) and extrinsic (meteorological and safety hazard) factors related to the injury. Retrospective chart review of 47 patients < 18 years old examining demographics, and intrinsic and extrinsic factors related to injuries. Demographic characteristics included sex, with whom the child lives with, illicit drug use, physical comorbidities, and region of residence. Injury characteristics included anatomical location, management, ambient temperature at the time of injury, exposure duration, injury circumstance, and factors related to injury including intoxication and supervision. Summary statistics are presented as median (IQR) or number (%) unless otherwise noted. Kolmogorov-Smirnov test was used to determine normality. Mann-Whitney U test was used to compare differences in median ambient temperature or median exposure duration between groups that had one or more procedures compared to none. Statistically significant differences between groups were defined as p < 0.05. Median age was 15 years (IQR 12–16) and 49% were admitted. Frequently documented risk activities included use of alcohol (53%), cigarettes (34%), marijuana (23%), and symptoms of depression and/or suicidality (32%). Although frostbite starts to present at ≤ -6°C, procedures were only required for frostbite occurring at temperatures ≤ -23°C (p = .001). Along with colder ambient temperature, long exposure duration (p < .001) was significantly related to likelihood of procedure, as opposed to conservative wound management. Two factors related to the injury were identified: intoxication and lack of supervision. Among patients 0–12 years, lack of supervision at time of injury was common (64%), while intoxication among older patients ages 13–17 was common (61%). To our knowledge, this is the largest retrospective study of pediatric frostbite. These findings call for targeted outreach to reduce frostbite incidence. For younger children, the focus must be on involving and educating parents on risks of unsupervised care. For older children, informing youth on risks of frostbite alongside approaches to curb adolescent alcohol use are warranted.

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