A Frostbite Treatment Guideline for Pediatric Patients

Abstract Despite the existence of guidelines for frostbite management in adults, there are no published attempts to standardize the treatment of pediatric frostbite. The purpose of this study is to describe a single institution multidisciplinary consensus guideline for the management of pediatric frostbite patients and review cases treated at our institution. The pediatric intensive care, interventional radiology, general surgery, and emergency medicine departments at a 300 bed tertiary referral children’s hospital developed and applied the proposed guideline for frostbite management in 2019. Patients who presented to the emergency department between 01/01/2012 and 3/12/2024 with a diagnosis of frostbite were retrospectively reviewed. Demographic information, grade of frostbite injury, and characterization of hospitalization and treatment course were noted and compared to the institutional guideline. 72 patients met inclusion criteria, of which 69 were managed with wound care alone. 15 required admission. There were 3 patients with grade 3 injury, 0 with grade 4 injury. One patient with grade 3 injury was seen prior to guideline implementation, did not receive tissue plasminogen activator thrombolysis, and eventually required amputation. The other two were seen after guideline implementation, received thrombolysis, and did not require amputation. The guideline for the treatment of frostbite in pediatric patients based on multidisciplinary consensus and following patient discussion provide a framework to consider when evaluating treatment options for children with frostbite.