{ "abstract": "Objectives Frostbite is a common reason for emergency department (ED) presentations in Canada. Iloprost, a prostacyclin analogue, has been investigated to reduce the risk of amputation with its use expanding. Two Canadian cities implemented iloprost over different times leading to a practice variation that allowed for treatment comparison. Our objective is to evaluate the effectiveness of iloprost compared with non-iloprost treatment. Secondary objectives include assessing the impact of iloprost dosage and homelessness.Methods A retrospective cohort study was conducted on adult severe frostbite cases presenting to EDs in Calgary and Edmonton between November 2021 and April 2024. Data were abstracted from clinical databases and analysed for demographic and injury characteristics, treatment and amputation outcomes.Results Of 1812 total ED encounters for frostbite, 257 patients with grades 2–4 extremity frostbite were included for analysis. Logistic regression found that overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95% CI 0.25 to 0.96) and fewer digit amputations (p<0.001). In particular, iloprost use was associated with reduced amputation rates in grade 3 injuries compared with non-iloprost care (30% vs 52%, p=0.042). Although over 80% of patients with grade 4 frostbite required amputations regardless of iloprost treatment, its use was associated with improved digit salvage, with 10% fewer digit segments requiring amputation in treated patients in both hands (p=0.049) and feet (p=0.003). When assessing 65 patients who received iloprost for limb frostbite, higher iloprost doses were associated with a lower likelihood of amputation (OR=0.35; 95% CI 0.13 to 0.91; p=0.03). In the patient subgroup who underwent at least one amputation, total iloprost dosage was inversely related to outcome (p=0.033, βST=−0.26). Adverse events were reported in 61% of iloprost-treated patients, with headache being the most common. Homelessness was found to be a significant predictor of delays in arrival to the ED after injury (p<0.001); OR=2.90 (95% CI 1.73 to 4.91).Conclusions Iloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases. Greater iloprost dosage was associated with improved digit salvage. Homelessness was associated with delayed ED presentation.", "authors": [ { "affiliations": [ "Emergency, Alberta Health Services, Edmonton, Alberta, Canada", "Clinical Operations/Research, Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada", "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Domhnall O’Dochartaigh" }, { "affiliations": [ "University College Dublin, Dublin, Leinster, Ireland", "Department of Critical Care, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Matthew J Douma" }, { "affiliations": [ "Nursing, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Christopher Picard" }, { "affiliations": [ "University of Alberta, Edmonton, Alberta, Canada" ], "name": "Efrem Violato" }, { "affiliations": [ "Surgery, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada" ], "name": "Alexander Poole" }, { "affiliations": [ "Whitehorse General Hospital, Whitehorse, Yukon, Canada" ], "name": "Josianne Gauthier" }, { "affiliations": [ "University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada" ], "name": "Alexis Armour" }, { "affiliations": [ "Kinesiology, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Daniel Tiwana" }, { "affiliations": [ "School of Nursing, University of Calgary, Calgary, Alberta, Canada", "Medicine, Alberta Health Services, Edmonton, Alberta, Canada" ], "name": "Ted Harrigan" }, { "affiliations": [ "Clinical Neurosciences and Surgery, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada" ], "name": "Vincent Gabriel" }, { "affiliations": [ "Departments of Clinical Neurosciences and Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada" ], "name": "Jevon Brown" }, { "affiliations": [ "Department of Medicine and Psychiatry, University of Calgary, Calgary, Alberta, Canada", "Department of General Internal Medicine and Neurology, University of Alberta, Edmonton, Alberta, Canada" ], "name": "S Monty Ghosh" }, { "affiliations": [ "University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada" ], "name": "Ian MacNairn" }, { "affiliations": [ "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Jaspreet Khangura" }, { "affiliations": [ "Alberta Health Services, Calgary, Alberta, Canada" ], "name": "Heather Boucher" }, { "affiliations": [ "University of Alberta, Edmonton, Alberta, Canada" ], "name": "Lindsay Robinson" }, { "affiliations": [ "Emergency, Alberta Health Services, Edmonton, Alberta, Canada" ], "name": "Lisa Watt" }, { "affiliations": [ "Public Health, Primary Care Alberta, Edmonton, Alberta, Canada" ], "name": "Jacob Van Nest" }, { "affiliations": [ "University of Alberta, Edmonton, Alberta, Canada" ], "name": "Johnathan l Bown" }, { "affiliations": [ "Alberta Health Services, Calgary, Alberta, Canada" ], "name": "Alexis Mageau" }, { "affiliations": [ "Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada" ], "name": "Sean Crooks" }, { "affiliations": [ "University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada" ], "name": "Yvonne Efegoma" }, { "affiliations": [ "University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada" ], "name": "Kimberly Byrnes" }, { "affiliations": [ "Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada" ], "name": "Stacey Middleton" }, { "affiliations": [ "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Jake Hayward" }, { "affiliations": [ "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Brian Whiteside" }, { "affiliations": [ "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada", "Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada" ], "name": "Kathryn Dong" }, { "affiliations": [ "Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada", "School of Public Health, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Elaine Hyshka" }, { "affiliations": [ "University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada" ], "name": "Michael Zakhary" }, { "affiliations": [ "Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada" ], "name": "Scott Maclean" } ], "title": "Comparison of iloprost therapy versus non-iloprost therapy for severe frostbite: a retrospective cohort study of two Canadian cities", "uid": "ba49ceba-83b5-554d-8f05-cda30cbd2a59" }