Morgan Schellenberg, Vincent Cheng, Kenji Inaba, Christopher Foran, Zachary Warriner, Marc D. Trust, Damon Clark, Demetrios Demetriades

Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America


Objective: Frostbite injuries are important causes of morbidity and mortality after trauma. Epidemiology, injury patterns, and outcomes after frostbite among patients presenting to trauma centers are incompletely defined. The purpose of this study was to delineate patient demographics, clinical characteristics, and independent predictors of outcomes after frostbite.

Material and Methods: Patients with frostbite injury were identified from the National Trauma Data Bank (NTDB) (2007-2014). Demographics, clinical/injury data, and outcomes were collected. Patients were dichotomized into study groups based on intensive care unit (ICU) admission. Univariate analysis was performed with the Mann-Whitney U, Fisher’s exact, or Chi-Square test as appropriate. Multivariate analysis using logistic regression determined independent predictors of outcomes.

Results: Over the study period, 241 patients were identified. Median body temperature on admission was 36.3⁰C (IQR 33.4-36.7). Mortality was 3% (n= 7). ICU admission was required in 101 (42%) patients and 48 (20%) underwent surgical intervention. On multivariate analyses, mortality was predicted by lower admission GCS (p= 0.027) and amputation by higher HR (p= 0.013). Need for ICU admission was predicted by older age (p= 0.010), male gender (p= 0.040), higher HR (p= 0.031) and ISS (p< 0.001), and lower GCS (p= 0.001). Prolonged hospital LOS was predicted by higher heart rate (p< 0.001) and ISS (p< 0.001).

Conclusion: Frostbite injuries are uncommon but can necessitate surgical intervention and cause mortality. Lower GCS and higher heart rate, but not body temperature, portend poor outcomes. These findings can be used to triage patients appropriately upon admission and to better inform prognosis after frostbite injuries.

Keywords: Frostbite, thermal injuries, hypothermia

Cite this article as: Schellenberg M, Cheng V, Inaba K, Foran C, Warriner Z, Trust MD, et al. Frostbite injuries: independent predictors of outcomes. Turk J Surg 2020; 36 (2): 218-223.


Ethics Committee Approval

Ethics committee approval by the Institutional Review Board of the University of Southern California was obtained (Approval granted January 28, 2019; Approval number is: HS-19-00015).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept – M.S., V.C.; Design – M.S., V.C., C.F., Z.W., M.D.T.; Supervision – M.S.; Resource – M.S., K.I., D.C., D.D.; Materials - M.S., K.I., D.C., D.D.; Data Collection and/or Processing - M.S., V.C., C.F., Z.W., M.D.T.; Analysis and/or Interpretation - M.S., V.C.; Literature Search M.S.; Writing Manuscript – M.S., V.C., K.I.; Critical Reviews – C.F., Z.W., M.D.T., D.C., D.D.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.