Peer-reviewed article
522 Safe Use of Thrombolytic Therapy for Severe Frostbite in Pediatric Patients
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This case series reports on thrombolytic therapy for severe frostbite in 13 children under 14 years old. Four children received thrombolytic treatment with no reported complications, while nine were managed conservatively. The study found that poor supervision and communication difficulties were risk factors for frostbite injury in children. Most children had good healing outcomes, though some had significant tissue loss. The authors conclude that thrombolytic therapy appears safe for use in pediatric frostbite.
Key points
- 13 pediatric frostbite cases were reviewed from 2006-2022, with 4 receiving thrombolytic therapy and 9 managed conservatively
- No complications were reported from thrombolytic therapy in either intravenous (2 patients) or intra-arterial (2 patients) administration
- 69% of patients were completely healed at follow-up; 23% had severe injury with likely tissue loss requiring amputation
- Risk factors identified include poor supervision at time of injury and inability to communicate (31% of children)
- Demographic data showed 38% Black or African American, 23% Asian, 23% Caucasian, and 8% Hispanic or Latino children
Limitations
This is a small, retrospective case series from a single center with incomplete follow-up (8% never followed up, 23% lost to follow-up), so outcomes cannot be fully assessed for all patients. The lack of a comparison group and small sample size limit the ability to draw firm conclusions about the efficacy of thrombolytic therapy compared to conservative management.
Abstract
Abstract Introduction Frostbite in children is very rare with few citations in the literature. Thrombolytic therapy is commonly used to salvage threatened tissue in frostbitten adults, but there is little to no data on the use of such therapy in children. The aim of this case series is to advance our understanding of pediatric frostbite by describing risk factors and outcomes, as well as commenting on the safety of thrombolytic therapy in this population. To our knowledge, thrombolytic therapy has not been studied in children, and this is the largest case series of pediatric frostbite to date. Methods This is a retrospective, single-center study reviewing cases of pediatric (< 14 years) frostbite from 2006-2022. Thirteen patients (6 males and 7 females) were found to fit inclusion criteria, and data was collected from the electronic medical record. Results A total of thirteen cases were reviewed. Nine patients were managed conservatively with diligent local wound cares, while four were prescribed thrombolytic therapy in an attempt at tissue salvage. Two patients underwent intravenous thrombolytic therapy, and two underwent intra-arterial thrombolytic therapy; there were no complications in either group. We also reviewed patient demographics. Thirty-eight percent of patients were documented as Black or African American, 23% Asian, 23% Caucasian, and 8% Hispanic or Latino. The remainder were unlisted. Notably, 31% of the children had trouble with communication (whether foreign speaking or non-verbal). None of the patients had a positive EtOH or urine drug screen. All of the children were poorly supervised when the frostbite occurred. Outcomes were as follows: 69% were completely healed upon follow up, 23% had very severe frostbite injury upon arrival with significant tissue loss likely requiring amputation (but did not return for follow up), and 8% never followed up. Conclusions The use of thrombolytics for the treatment of frostbite injury appears to be safe in children. We have found that risk factors for frostbite in this population include an inability to communicate and poor supervision at the time of injury. Applicability of Research to Practice We have been able to safely treat children presenting with severe frostbite injury with thrombolytic therapy. This work is highly applicable to practice. Specifically, the ability to administer intravenous thrombolytic therapy is nearly ubiquitous. This can be done at referring hospitals if there are issues with inclement weather or transportation that would delay transfer to a verified burn center.