Synthesis of Protocols for Frostbite Care from the FROST Study Sites

Rachel M Nygaard; Emily Colonna; Alexander Poole; Lee D Faucher; Rosemary E Paine; Naveen Sangji; Alexandra Lacey; Dhaval Bhavsar; Kristin Colling; Alexis Armour; Irma Fleming; Arek Wiktor; Lucy Wibbenmeyer; FROST multicenter study team

doi:10.1093/jbcr/irag111

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Synthesis of Protocols for Frostbite Care from the FROST Study Sites

Journal article

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Synthesis of Protocols for Frostbite Care from the FROST Study Sites

Rachel M Nygaard, Emily Colonna, Alexander Poole, Lee D Faucher, Rosemary E Paine, Naveen Sangji, Alexandra Lacey, Dhaval Bhavsar, Kristin Colling, Alexis Armour, …

Journal of burn care & research

07/01/2026

DOI: 10.1093/jbcr/irag111

PMID: 42384943

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Abstract

Frostbite injuries can have lasting sequelae including amputations, intolerance to cold, chronic pain, paresthesia, and inability to return to work. Despite this morbidity, the treatment of frostbite remains understudied. The FRostbite ObServational Trial (FROST) aims to address this gap through a multicenter evaluation of treatment practices and outcomes. As part of FROST, we reviewed institutional frostbite care protocols from 16 participating sites across North America. Practices were categorized as demonstrating uniform agreement $\Big(\ge$90% mentioned the practice), consensus ($\ge$75%), or majority if ($\ge$50%). Uniform agreement was limited to use of rapid rewarming and thrombolytics, the latter being influenced by site selection criteria for FROST participation. Consensus was achieved in multiple areas (such as urgency of treatment, perfusion assessment, the therapeutic windows for pharmaceutical interventions, and the therapeutic dosing of IV thrombolytics). Protocols varied on grades for thrombolytic treatment initiation, prostacyclin analogue use, post-thrombolytic anticoagulation treatment and duration, the role of physical or occupational therapy, splinting, and appropriate wound care. This manuscript provides a synthesis of protocols and expert opinion for the acute management of frostbite injury. This synthesized protocol may serve as a tool for centers to develop their own standard protocol to facilitate care for frostbite patients. Additionally, current opportunities for frostbite research and improving care are detailed in the manuscript. Education regarding prevention of injury and the need for emergent treatment is needed for both the public and the medical community.

clinical management

frostbite protocol

Frostbite

clinical protocol

frostbite treatment protocol

frostbite clinical management

frostbite management

freezing cold injury

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Details

Title: Subtitle: Synthesis of Protocols for Frostbite Care from the FROST Study Sites
Creators: Rachel M Nygaard - Hennepin County
Emily Colonna - Hennepin Healthcare Research Institute
Alexander Poole - Yukon University
Lee D Faucher - University of Wisconsin–Madison
Rosemary E Paine - MaineHealth
Naveen Sangji - University of Michigan
Alexandra Lacey - Regions Hospital
Dhaval Bhavsar - The University of Kansas Health System
Kristin Colling - Essentia Health
Alexis Armour - University of Alberta
Irma Fleming - University of Utah
Arek Wiktor - University of Colorado Hospital
Lucy Wibbenmeyer - University of Iowa Health Care
FROST multicenter study team
Resource Type: Journal article
Publication Details: Journal of burn care & research
DOI: 10.1093/jbcr/irag111
PMID: 42384943
ISSN: 1559-0488
eISSN: 1559-0488
Publisher: Oxford University Press
Language: English
Electronic publication date: 07/01/2026
Academic Unit: Surgery; Injury Prevention Research Center
Record Identifier: 9985179092302771

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