{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:20:39Z","timestamp":1784784039616,"version":"3.55.0"},"reference-count":25,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032904","name":"Alberta Registered Nurses Education Trust","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032904","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,1]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Frostbite is a common reason for emergency department (ED) presentations in Canada. Iloprost, a prostacyclin analogue, has been investigated to reduce the risk of amputation with its use expanding. Two Canadian cities implemented iloprost over different times leading to a practice variation that allowed for treatment comparison. Our objective is to evaluate the effectiveness of iloprost compared with non-iloprost treatment. Secondary objectives include assessing the impact of iloprost dosage and homelessness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted on adult severe frostbite cases presenting to EDs in Calgary and Edmonton between November 2021 and April 2024. Data were abstracted from clinical databases and analysed for demographic and injury characteristics, treatment and amputation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1812 total ED encounters for frostbite, 257 patients with grades 2\u20134\u2009extremity frostbite were included for analysis. Logistic regression found that overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95%\u2009CI 0.25 to 0.96) and fewer digit amputations (p&lt;0.001). In particular, iloprost use was associated with reduced amputation rates in grade 3 injuries compared with non-iloprost care (30% vs 52%, p=0.042). Although over 80% of patients with grade 4 frostbite required amputations regardless of iloprost treatment, its use was associated with improved digit salvage, with 10% fewer digit segments requiring amputation in treated patients in both hands (p=0.049) and feet (p=0.003). When assessing 65 patients who received iloprost for limb frostbite, higher iloprost doses were associated with a lower likelihood of amputation (OR=0.35; 95%\u2009CI 0.13 to 0.91; p=0.03). In the patient subgroup who underwent at least one amputation, total iloprost dosage was inversely related to outcome (p=0.033, \u03b2ST=\u22120.26). Adverse events were reported in 61% of iloprost-treated patients, with headache being the most common. Homelessness was found to be a significant predictor of delays in arrival to the ED after injury (p&lt;0.001); OR=2.90 (95% CI 1.73 to 4.91).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Iloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases. Greater iloprost dosage was associated with improved digit salvage. Homelessness was associated with delayed ED presentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110475","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:50:34Z","timestamp":1779115834000},"page":"e110475","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of iloprost therapy versus non-iloprost therapy for severe frostbite: a retrospective cohort study of two Canadian cities"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2186-2657","authenticated-orcid":false,"given":"Domhnall","family":"O\u2019Dochartaigh","sequence":"first","affiliation":[{"name":"Emergency, Alberta Health Services, Edmonton, Alberta, Canada"},{"name":"Clinical Operations\/Research, Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada"},{"name":"Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Douma","sequence":"additional","affiliation":[{"name":"University College Dublin, Dublin, Leinster, Ireland"},{"name":"Department of Critical Care, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Picard","sequence":"additional","affiliation":[{"name":"Nursing, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-2384","authenticated-orcid":false,"given":"Efrem","family":"Violato","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8842-6852","authenticated-orcid":false,"given":"Alexander","family":"Poole","sequence":"additional","affiliation":[{"name":"Surgery, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josianne","family":"Gauthier","sequence":"additional","affiliation":[{"name":"Whitehorse General Hospital, Whitehorse, Yukon, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Armour","sequence":"additional","affiliation":[{"name":"University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tiwana","sequence":"additional","affiliation":[{"name":"Kinesiology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Harrigan","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Calgary, Calgary, Alberta, Canada"},{"name":"Medicine, Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Clinical Neurosciences and Surgery, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jevon","family":"Brown","sequence":"additional","affiliation":[{"name":"Departments of Clinical Neurosciences and Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Monty","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Medicine and Psychiatry, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of General Internal Medicine and Neurology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"MacNairn","sequence":"additional","affiliation":[{"name":"University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaspreet","family":"Khangura","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Boucher","sequence":"additional","affiliation":[{"name":"Alberta Health Services, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Robinson","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Watt","sequence":"additional","affiliation":[{"name":"Emergency, Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Van Nest","sequence":"additional","affiliation":[{"name":"Public Health, Primary Care Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnathan l","family":"Bown","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Mageau","sequence":"additional","affiliation":[{"name":"Alberta Health Services, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Crooks","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Efegoma","sequence":"additional","affiliation":[{"name":"University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Byrnes","sequence":"additional","affiliation":[{"name":"University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Middleton","sequence":"additional","affiliation":[{"name":"Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Hayward","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Whiteside","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine and Dendistry, University of Alberta, Edmonton, Alberta, Canada"},{"name":"Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5785-8890","authenticated-orcid":false,"given":"Elaine","family":"Hyshka","sequence":"additional","affiliation":[{"name":"Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"School of Public Health, University of Alberta, 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Public Health Recommendations to Reduce the Impacts of Exposure to Winter Weather on People Experiencing Homelessness in British Columbia, 2023. Available: http:\/\/www.bccdc.ca\/resource-gallery\/Documents\/Guidelines%20and%20Forms\/Guidelines%20and%20Manuals\/Health-Environment\/Recommendations_Exposure_Winter_Weather_People_Experiencing_Homelessness.pdf"},{"key":"2026060801251492000_16.5.e110475.22","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/disa.12400","article-title":"There\u2019s nowhere to go: counting the costs of extreme weather to the homeless community","volume":"43","author":"Every","year":"2019","journal-title":"Disasters"},{"key":"2026060801251492000_16.5.e110475.23","doi-asserted-by":"publisher","DOI":"10.1177\/10806032231222359"},{"key":"2026060801251492000_16.5.e110475.24","unstructured":"The HomeWard Trust Data . Analytics & reporting; measuring and reporting on homelessness data and trends. 2025. 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