Frostbite vs Burns: Increased Cost of Care and Use of Hospital Resources

Numerous demographic, socioeconomic, and injury factors influence a burn patient's hospital course. Compared to the typical burn patient, frostbite injury frequently impacts those with high rates of mental illness, substance abuse, and those suffering homelessness. Our aim was to examine differences in the hospital course of frostbite patients compared to those with burns limited to the hands and feet. Patients with frostbite injury and those with isolated hand and/or foot burns were identified in the National Burn Repository. The database was cleaned based on published protocols. Patients were excluded if they had an inhalation injury recorded or unknown. Patients with frostbite injury were significantly older and more likely to be male. Frostbite patients were less frequently covered by commercial insurance (25.3% vs 41.7%). Mean total BSA (TBSA) did not differ between the two groups (frostbite: 2.1 and burn: 1.7, P = .195). The mean intensive care unit (ICU) days and requirement for mechanical ventilation were not significantly different between the two groups, however frostbite patients were significantly more likely to require ICU care (26.5% vs 13.7%, P = .002). Hospital length of stay (LOS) was significantly longer in frostbite patients (8.1 vs 4.0 days, P < .001) and hospital charges were significantly higher in frostbite patients ($43,400 vs $15,600, P < .001). Factors associated with increased hospital charges included mechanism, age, gender, race, TBSA, hospital LOS, ICU, and mechanical ventilation. Factors associated with increased LOS included mechanism, age, gender, race, TBSA, ICU stay, and mechanical ventilation. On multivariate analysis, all factors, except gender, remained independent predictors of increased hospital LOS. A comparison of similarly injured patients treated at burn centers showed frostbite injury as a significant predictor of increased LOS and hospital costs compared to burn-injured patients.