Remote delivery of thrombolytics prior to transfer to a regional burn center for tissue salvage in frostbite: A single center experience of 199 patients.

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J Burn Care Res


washington; olympia; psph


While much has been published on efficacy and safety of systemic thrombolytics in the treatment of acute frostbite, there has been limited investigation into administration outside a tertiary care setting. Here, we present a single-center experience with remote initiation of intravenous tissue plasminogen activator (tPA) at referring hospitals prior to transfer to a regional burn center. A modified Hennepin Quantification Score based on tissue involvement was used to determine eligibility for tPA and to quantify severity of amputation. This is a retrospective review of patients with acute frostbite of the digits admitted to a single verified burn center over a five-year period. Of 199 patient admissions, 40 received tPA remotely pre-transfer, 32 received tPA on admission to our institution, and 127 patients did not qualify for tPA therapy according to the protocol. Comparing patients who required any amputation (n=99, 49.7%) to those who did not, patients who received remote tPA had lower odds of any amputation compared to both those receiving tPA at our institution (OR 0.19, 95% CI 0.05 - 0.65, p=0.01) and the group receiving no tPA (OR 0.14, 95% CI 0.05 - 0.40, p


Emergency Medicine