Uncertainty in the estimates and burden benefits, risks and burden may be closely balancedĪn 11-year retrospective analysis (1 January 2003–31 December 2014) of all cold injuries presenting to a large regional burn centre in the UK was conducted. Weak recommendation, low-quality or very low-quality evidence Weak recommendation, moderate-quality evidence Weak recommendation, high-quality evidenceīenefits closely balanced with risks and burdens Strong recommendation, low-quality or very low-quality evidence RCTs with important limitations or exceptionally strong evidence from observational studies Strong recommendation, moderate-quality evidenceīenefits clearly outweigh risks and burdens or vise versa RCTs without important limitations or overwhelming evidence from observational studies Strong recommendations, high-quality evidenceīenefits clearly outweigh risks and burdens or vice versa Methodological quality of supporting evidence This article focuses more on the cutaneous manifestation and treatment of cold injury rather than deep injury. Our recommendations are based on evidence graded using the American College of Chest Physicians (ACCP) classification criteria for grading evidence in clinical guidelines (see Table 1). We also conducted a review of current literature to provide a simplified management pathway of cutaneous cold injuries. Additionally, a nationwide survey was disseminated to plastic surgeons in the UK to assess the current level of knowledge regarding managing cold burn injuries. We performed a study to review our experience with the assessment and treatment of cold burn injuries. The management of these burns differs from the standard management of thermal injuries. Cold burns can occur through a variety of mechanisms ranging from prolonged exposure in a cold environment to the self-inflicted wounds from a seemingly benign aerosol can. This may be partly because these injuries are relatively uncommon in comparison to other forms of burn injuries.įrostbite or cold burn is the medical condition in which localized damage is caused to skin and other tissues due to freezing. Whist the national guidelines for burn resuscitation have been clearly outlined worldwide and taught through internationally recognized courses such as the Emergency Management of Severe Burns (EMSB) course, we feel that national guidance for the management of cold induced burn injuries is not widely available to clinicians. Extensive research has been conducted to improve management of thermal burns. Guidance for the management of thermal injuries has evolved accordingly with improved understanding of the pathophysiology of burn injuries.
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