Impact of Thrombolytic Treatment on Functional Rehabilitation in Severe Frostbite Patients

Thrombolytics improve limb and digit salvage following severe frostbite injury, however disability following thrombolytics therapy is largely undescribed. Our aim was to evaluate functional status, pain, and disability in a large cohort of severe frostbite patients treated with and without thrombolytics, hypothesizing no significant differences between the two groups. Longitudinal cohort study of severe frostbite injured patients over the winters of 2013-20. Therapy and clinic notes were reviewed at discharge and follow-up. Outcomes were categorized including requiring assistance or modifications for activities of daily living (ADLs), grip, ambulation status (independent, assist-device, non-ambulatory), presence of pain, edema, numbness, throbbing, and hyperesthesia. The cohort included 182 patients, 75.8% received thrombolytics. Over a third of patients required assistance with ADLs (32.6% no thrombolytics vs 46.7% thrombolytics, p=0.115). Return to work status as same prior to injury were equal between the two treatment groups. Reports of neurologic pain, edema, and numbness were all higher in the thrombolytics treated group, while throbbing was higher in the non-thrombolytics group, but none reached significance. Significantly more non-thrombolytics treated patients required amputation. Of those with at least 1 clinic follow-up (n=133), 98 were treated with thrombolytics. Higher proportions of thrombolytics patients were independently ambulating at follow-up. No significant differences in reported pain, edema, swelling, hyperesthesia, or throbbing between the treatment groups were observed at follow-up. When examining those treated with or without thrombolytics that did not require amputation, the results mirrored the cohort. When assessing outcomes based on extremity impacted by frostbite, only independent ambulation was significantly higher in those with lower extremity injury treated with thrombolytics. This is the first long-term evaluation of functional outcomes of thrombolytics-treated severe frostbite patients. Future research is needed to incorporate the systematic documentation of functional outcomes using validated performance and patient-reported outcomes measures. Thrombolytics is a valuable intervention in preventing amputation following severe frostbite injury and functional recovery of salvaged limbs and digits warrant additional study.