title: A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital.
abstract: BACKGROUND
  Frostbite is a common yet challenging injury to both diagnose and treat. McCauley's frostbite treatment protocol consists of 12 treatments that might well represent the standard of care. However, its effectiveness in preventing operative intervention has yet to be examined. Our objectives were to characterize frostbite injuries in Eastern Ontario, identify risk factors for deep injuries, and assess the protocol's efficacy in preventing operative outcomes.
  
  
  METHODS
  This cohort study examined patients with frostbite over ten years at a tertiary care hospital. Demographics and predisposing factors were recorded. Frostbite severity was categorized into superficial or deep. Treatments were recorded, including adherence to protocol and operative outcome.
  
  
  RESULTS
  Of the 265 frostbite patients identified, deep frostbite accounted for 56 (21.1%, 95% CI: 16.2-26.1%), of whom 20 (35.7%) had an operative outcome. Amputation occurred in 16 (28.6%) of deep injuries and debridement in 5 (8.9%). Risk factors for deep frostbite were older age (p =0.002), smoking (p <0.001), male sex (p =0.056) and alcohol abuse (p =0.056). None of the patients with deep frostbite had all 12 treatments performed. Adherence to protocol ranged from 0.0% to 48.2% per treatment. The rate of operative intervention was 7.7% in patients with deep frostbite who did not have any McCauley's frostbite treatments and ranged from 0.0% to 100.0% per treatment in those who did receive treatments.
  
  
  CONCLUSIONS
  The frostbite protocol was not regularly followed and therefore its efficacy in preventing operative intervention could not be determined. Further, none of the individual treatments in the protocol were associated with preventing operative intervention. We recommend that future research focus on identifying effective individual treatments.
authors.affiliation: *University of Ottawa, Faculty of Medicine,Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Jaroslav Christopher
authors.initials: JC
authors.lastname: Fabian
authors.affiliation: *University of Ottawa, Faculty of Medicine,Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: *University of Ottawa, Faculty of Medicine,Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D002985:Clinical Protocols; D003646:Debridement; D005260:Female; D005627:Frostbite / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
keywords: Amputation; Frostbite; Treatment-protocol