706 Frostbite and Drugs of Abuse: Friend or Foe?
Abstract Introduction In the literature, the incidence of alcohol and/or drug use among burn patients ranges from 16.4%-69%. Burn patients with positive toxicology (tox) screens on admission are known to have increased rates of morbidity and mortality. To date little has been published on the effects of positive alcohol and/or drug screens on outcomes in the frostbite population. The objective of this study was to investigate the incidence of drugs and alcohol use in admitted patients with severe frostbite and their association with clinical outcomes. Methods A retrospective cohort study was conducted on 141 frostbite patients admitted to a verified burn center from November 2015 to March 2019. Patients were identified using our burn registry and relevant data was obtained through chart reviews. The primary comparison was between patients with and without a positive tox screen on admission, assessing administration of thrombolytics (tPA) and rates of amputation. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used for continuous variables, reporting, two-tailed p values. Results Tox screens were positive in 77.3% (109) of frostbite patients: 52.5% (74) for marijuana and 56.7% (80) for alcohol. Homelessness accounted for 50.4% (71) and 63.1% (89) were tobacco users. Compared to patients with negative tox screens, significantly higher rates of amputation were found in those using marijuana (p=0.016), other drugs of abuse (p=0.008) and tobacco (p=0.0093). Significantly higher limb salvage rates were found in patients presenting with a negative tox screen (p=0.0077). Only tobacco users had a significantly greater length of stay (p=0.02). 36.2% (51) of the patients received tPA with no difference in administration rates between positive and negative tox screened patients. Patients receiving tPA had significantly lower rates of amputation (p=0.02). 51.8% (73) of admitted patients were homeless, with 83.6% (61) testing tox positive. Both increased hospital length of stay (p=< 0.001) and amputation rates (p=0.0004) were observed in the homeless frostbite population. Conclusions Drugs, alcohol and homelessness significantly impact clinical outcomes in frostbite patients. Homelessness, marijuana, tobacco and other drugs of abuse are associated with significantly higher rates of amputation despite receiving tPA at the same rate. Administration of tPA is significant in lowering amputation rates. Applicability of Research to Practice The association between drugs of abuse, homelessness and frostbite highlight the need for increased preventative efforts especially in the homeless population.