The Cold, Hard Facts: A Preliminary Study Evaluating the Psychiatric Context of Urban Hospital Presentations for Frostbite

Background:

Frostbite is a preventable cold-weather injury with incidence linked to chronic mental illness, substance use, and undomiciled status in more extreme climate studies (Urschel 1990, Ikaheimo 2011), but frostbite’s psychiatric context has received limited scrutiny in urban settings within the continental U.S. (Pinzer 1997). We examined the prevalence of mental illness and substance abuse in patients presenting with frostbite to Chicago-area hospitals affiliated with Northwestern.


Methods:

Institutional review board approval was obtained to review hospital records of patients 18 years or older who were diagnosed with frostbite during presentation to a Northwestern-affiliated emergency department (ED) between June 2010 and June 2020, excluding cases of non-climate-related injury (e.g. chemical burns). This preliminary study was limited to patients who signed written consent for research with clinical data.


Results:

Of 41 subjects, 70% were male. Most were Caucasian (41.5%) or African American (46.3%). Sixteen (39%) were undomiciled. Half (51.2%) had a substance use diagnosis and 29.2% a psychotic illness. Of the 6 patients who required inpatient medical admission, 2 were undomiciled with decompensated psychosis requiring pursuit of court-ordered treatment and guardianship, 2 had significant alcohol use disorders, and 1 had a severe opioid use disorder with heroin overdose preceding admission. Of the four subjects who had repeated ED presentations, all were undomiciled and had substance use disorders. Psychiatric consultation was requested in three (50%) of the hospitalized patient and one ED patient.


Discussion:

Consistent with findings from more extreme climates, psychotic illness and substance use disorders were common among frostbite victims in an urban environment. While most did not require hospitalization, a majority of those who did (as well as those who had repeated presentations) had severe psychiatric illness or substance use disorders, and many were undomiciled. This suggests that factors such as sedated intoxication, psychosis-impaired judgement, lack of housing, and lack of environmental awareness due to mental illness play a role in frostbite vulnerability, particularly in more severe cases. Our future, de-identified data study of the full 10 year sample of frostbite presentations will provide clearer prevalence data regarding these factors.


Conclusion:

Substance use disorders and psychotic illness are common in patients presenting with frostbite – an uncommon but very serious consequence of the burden of illness in this population. Given this association, routine psychiatric evaluation of frostbite victims may be of benefit in identifying and addressing treatment needs, potentially decreasing risk of reinjury by this mechanism, as well as from the myriad other health risks faced by this population.


References

Ikaheimo TM, Hassi J. Frostbite in circumpolar areas. Glob Health Action 2011;4:4856.

Pinzur MS, Weaver FM. Is urban frostbite a psychiatric disorder? Orthopedics 1997;20(1):43-45.

Urschel JD; Frostbite: predisposing factors and predictors of poor outcome. J Trauma 1990;30(3):340-342.