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Regli IB, Oberhammer R, Zafren K, Brugger H, Strapazzon G. Frostbite treatment: a systematic review with meta-analyses. Scand J Trauma Resusc Emerg Med 2023; 31:96. [PMID: 38072923 PMCID: PMC10712146 DOI: 10.1186/s13049-023-01160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. MAIN BODY We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. CONCLUSIONS Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment.
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Affiliation(s)
- Ivo B Regli
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100, Bolzano, BZ, Italy.
- Dr. Regli's Alpine Medical Services and Research, Unterägeri, ZG, Switzerland.
- Department of Internal and Emergency Medicine, Bürgerspital, Solothurn, SO, Switzerland.
| | - Rosmarie Oberhammer
- Department of Anesthesia and Intensive Care, Hospital of Brunico, Brunico, BZ, Italy
| | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, USA
- Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100, Bolzano, BZ, Italy
- Department of Anesthesia and Intensive Care, Medical University Innsbruck, Innsbruck, Tyrol, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100, Bolzano, BZ, Italy
- Department of Anesthesia and Intensive Care, Medical University Innsbruck, Innsbruck, Tyrol, Austria
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Gauthier J, Morris-Janzen D, Poole A. Iloprost for the treatment of frostbite: a scoping review. Int J Circumpolar Health 2023; 82:2189552. [PMID: 36966492 PMCID: PMC10044161 DOI: 10.1080/22423982.2023.2189552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023] Open
Abstract
We performed a scoping review to identify the extent of the literature describing the use of iloprost in the treatment of frostbite. Iloprost is a stable synthetic analog of prostaglandin I2. As a potent inhibitor of platelet aggregation and vasodilator, it has been used to address the post-rewarming reperfusion injury in frostbite. The search using iloprost and frostbite as key words and MeSH terms yielded 200 articles. We included in our review the literature examining iloprost for the treatment of frostbite in humans in the form of primary research, conference proceedings and abstracts. Twenty studies published from 1994 to 2022 were selected for analysis. The majority were retrospective case series consisting of a homogeneous population of mountain sport enthusiasts. A total of 254 patients and over 1000 frostbitten digits were included among the 20 studies. The larger case series demonstrated a decrease in amputation rates relative to untreated patients. Primary gaps in the literature include a paucity of randomised trials and relatively limited study populations to date. While the case evidence is promising, a multi-centre collaboration would be crucial to adequately power prospective randomised studies to definitively determine if iloprost has a role in the treatment of frostbite.
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Affiliation(s)
- Josianne Gauthier
- Whitehorse General Hospital, Yukon Hospital Corporation, Whitehorse, Yukon, Canada
| | - Dunavan Morris-Janzen
- Northern Medical Program, University of British Columbia, Prince George, British Columbia, Canada
| | - Alexander Poole
- Whitehorse General Hospital, Yukon Hospital Corporation, Whitehorse, Yukon, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Sun J, Fu L, Zhang W, Li D, Zhang M, Xu Z, Bai H, Ding P. Convolutional neural network models for automatic diagnosis and graduation in skin frostbite. Int Wound J 2023; 20:910-916. [PMID: 36054618 PMCID: PMC10031220 DOI: 10.1111/iwj.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022] Open
Abstract
The study aimed to develop and validate a convolutional neural network (CNN)-based deep learning method for automatic diagnosis and graduation of skin frostbite. A dataset of 71 annotated images was used for the training, the validation, and the testing based on ResNet-50 model. The performances were evaluated with the test set. The diagnosis and graduation performance of our approach was compared with two residents from burns department. The approach correctly identified all the frostbite of IV (18/18, 100%), but with respectively 1 mistake in the diagnosis of degree I (29/30, 96.67%), II (28/29, 96.55%) and III (37/38, 97.37%). The accuracy of the approach on the whole test set was 97.39% (112/115). The accuracy of the two residents were respectively 77.39% and 73.04%. Weighted Kappa of 0.583 indicates good reliability between the two residents (P = .445). Kendall's coefficient of concordance is 0.326 (P = .548), indicating differences in accuracy between the approach and the two residents. Our approach based on CNNs demonstrated an encouraging performance for the automatic diagnosis and graduation of skin frostbite, with higher accuracy and efficiency.
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Affiliation(s)
- Jiachen Sun
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Lin Fu
- Plastic Surgery Hospital of Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina
| | - Wen Zhang
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Dongjie Li
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Ming Zhang
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Zineng Xu
- R&D DepartmentDeepcare Inc.BeijingChina
| | | | - Peng Ding
- R&D DepartmentDeepcare Inc.BeijingChina
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Castellani JW, Eglin CM, Ikäheimo TM, Montgomery H, Paal P, Tipton MJ. ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise. Curr Sports Med Rep 2021; 20:594-607. [PMID: 34752434 DOI: 10.1249/jsr.0000000000000907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Cold injury can result from exercising at low temperatures and can impair exercise performance or cause lifelong debility or death. This consensus statement provides up-to-date information on the pathogenesis, nature, impacts, prevention, and treatment of the most common cold injuries.
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Affiliation(s)
- John W Castellani
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA
| | - Clare M Eglin
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
| | | | - Hugh Montgomery
- University College London, Centre for Human Health and Performance, London, United Kingdom
| | - Peter Paal
- Hospitallers Brothers Hospital, Anaesthesiology and Intensive Care Medicine, Salzburg, Austria
| | - Michael J Tipton
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
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Poole A, Gauthier J, MacLennan M. Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series. CMAJ Open 2021; 9:E585-E591. [PMID: 34021017 PMCID: PMC8177911 DOI: 10.9778/cmajo.20200214] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol. METHODS This was a retrospective case series from Whitehorse General Hospital, Whitehorse, Yukon Territory, Canada. We reviewed the charts of patients who presented to the hospital with grade 2-4 frostbite and were treated as per our protocol between Feb. 9, 2015, and Feb. 8, 2020. Patients with grade 2-4 frostbite received iloprost; in addition, those with grade 4 frostbite received alteplase and heparin. We determined the number of digits affected and salvaged, and the time from presentation to the emergency department to treatment initiation. We also examined patients' demographic characteristics, predisposing events, frostbite severity and adverse drug reactions. RESULTS In 22 patients treated for grade 2-4 frostbite, 142 digits were affected: 59 with grade 2 frostbite, 25 with grade 3 frostbite and 58 with grade 4 frostbite; of the 142, 113 (79.6%) were salvaged. All 29 digits amputated had grade 4 frostbite. The mean time from presentation to iloprost initiation was reduced from 32.9 hours in 2015 to 3.0 hours in 2020. Sports (10 cases [45%]) and alcohol use (6 [27%]) were the most common precipitating events, with alcohol use tending to result in more severe injury (grade 4 in 5 of 6 cases). Adverse reactions with iloprost (e.g., headache) were common but mild. Adverse reactions with alteplase (e.g., bleeding) were less common but of greater clinical significance. INTERPRETATION Over the study period, our protocol contributed to improvement in frostbite care at our institution, resulting in a digit salvage rate comparable to other published results. Our 5-year experience shows that advanced medical care of frostbite can be achieved, even at a rural centre.
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Affiliation(s)
- Alexander Poole
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass.
| | - Josianne Gauthier
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass
| | - Mira MacLennan
- Whitehorse General Hospital (Poole), Whitehorse, Yukon; Department of Surgery (Poole), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Whitehorse General Hospital (Gauthier), Yukon Hospital Corporation, Whitehorse, Yukon; University of Saskatchewan (Gauthier), Saskatoon, Sask.; Department of Surgery (MacLennan), McMaster University, Hamilton, Ont.; Harvard T.H. Chan School of Public Health (MacLennan), Boston, Mass
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Santiago MB, Paz A. Acute Peripheral and/or Cutaneous Ischemic Syndrome: What Rheumatologists Should Know. J Clin Rheumatol 2021; 27:73-79. [PMID: 33315786 DOI: 10.1097/rhu.0000000000001609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In daily practice, the frequent appearance of limb and/or skin necrosis, which we term "acute peripheral and/or cutaneous ischemic syndrome" (APCIS), can be a manifestation of numerous underlying diseases, or it can sometimes be a clinical phenomenon whose etiology is undefined even after a wide investigation. The mechanisms for the development of APCIS include vessel wall abnormalities (atherosclerosis, vasculitis, and calciphylaxis), embolic processes (infectious endocarditis, atrial myxoma, and cholesterol emboli), local thrombotic injuries (genetic or acquired thrombophilias and heparin- and warfarin-induced ischemia), dysproteinemias (cryoglobulinemia and cryofibrinogenemia), or venous limb gangrene. Here, we report 5 illustrative cases of APCIS with different pathogenetic mechanisms, thereby highlighting some clinical conditions that cause APCIS that may be of special interest for rheumatologists, such as antiphospholipid syndrome, primary and secondary vasculitis, and cryoproteinemias. Furthermore, we describe a large spectrum of other causes of APCIS beyond the scope of rheumatology. Because there are no validated guidelines for APCIS, we tentatively propose an initial diagnostic workup and a therapeutic approach based on full-dose anticoagulation and immunosuppressive therapy.
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Affiliation(s)
| | - Adriane Paz
- From the Hospital Universitário Professor Edgard Santos
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