{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T03:02:01Z","timestamp":1787626921636,"version":"build-2736575974"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Approximately 30% of severe frostbite injuries result in amputation. Thrombolytic therapy is used to reduce tissue loss following severe frostbite injury. This study evaluates factors impacting the effectiveness of thrombolytics using post-treatment perfusion imaging and amputation level as outcome measures. We hypothesize that categorizing thrombolytic-treated patients into full, partial, and nonresponders enable a nuanced evaluation of treatment effectiveness. A prospectively maintained frostbite database was reviewed for patients with post-rewarming perfusion deficits measured by Tc99 scans who received IV thrombolytics. Of 131 patients, 71% were full responders, 23.7% were partial responders, and 5.3% were nonresponders for surgical outcome. The median time to thrombolytics was 5.5 h (range 1-14.5) for full responders; 7 h (range 3.5-14) for partial responders; and 10 h (range 1.5-11.5) for nonresponders. Full responders exhibited smaller initial perfusion deficits. Psychosocial or comorbid factors were not significantly different across groups. Nonresponse was associated with a longer time to thrombolytics, larger perfusion deficits, and cellulitis\/infection. Using imaging outcomes to reduce confounding by infection, 93 patients were evaluated: 28% were full responders, 57% were partial responders, and 15% were nonresponders. Full responders for imaging outcomes corresponded with surgical outcomes and had no amputations, while 37.7% of partial responders and 42.9% of nonresponders on imaging outcomes had amputations. This study is the largest to evaluate thrombolytic outcomes in severe frostbite-injured patients, showing nearly 95% of patients improve after thrombolytic treatment for severe frostbite injury. This provides new insight into thrombolytic responses and a novel assessment of thrombolytic treatment efficacy. These findings underscore the importance of timely thrombolytic administration and demonstrate benefits for patients treated outside the standard thrombolytic treatment windows.<\/jats:p>","DOI":"10.1093\/jbcr\/iraf051","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T07:45:31Z","timestamp":1744357531000},"page":"730-740","source":"Crossref","is-referenced-by-count":4,"title":["Time to Thrombolytics and Tissue Salvage: Assessing Response Following Severe Frostbite Injury"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2807-519X","authenticated-orcid":false,"given":"Rachel M","family":"Nygaard","sequence":"first","affiliation":[{"name":"Department of Surgery, Hennepin County Medical Center, Hennepin Healthcare , Minneapolis, MN 55415 ,","place":["United 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Minneapolis, MN 55415 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopal","family":"Punjabi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hennepin County Medical Center, Hennepin Healthcare , Minneapolis, MN 55415 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5774-4444","authenticated-orcid":false,"given":"Alexandra","family":"Lacey","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hennepin County Medical Center, Hennepin Healthcare , Minneapolis, MN 55415 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hennepin County Medical Center, Hennepin Healthcare , Minneapolis, MN 55415 ,","place":["United 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