{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T03:01:17Z","timestamp":1787626877002,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Frostbite is a cold-weather injury presenting a significant risk of functional morbidity due to amputation. There is a paucity of studies investigating the epidemiology and regional distribution of frostbite. We describe the characteristics of frostbite patients and their care in Ontario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data were collected from the Institute of Clinical and Evaluative Sciences for adults over 18 years presenting to an Ontario emergency department from 1 January 2010 to 31 December 2018. Patients were followed for 30-day readmission and additional treatments within 180 days of presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Five thousand three hundred and eleven patients presented with unique episodes of frostbite in Ontario. Most cases were classified as unspecified (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3775) or superficial (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1379) frostbite of the extremities, primarily in male patients with a mean age 40 and few comorbidities. Cases were seen across all income and marginalisation quintiles, with a trend towards more cases in greater Ontario Marginalization indices and a higher proportion of homelessness seen in deep frostbite presentations (10%) compared to superficial (4.4%) or unspecified (5.6%). Most cases (75%) presented to small or medium-sized non-academic hospitals. An increase in cases was seen in extreme cold winters in 2014 and 2015.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Frostbite patients presented to small and medium non-academic hospitals with increased cases during extreme cold weather. While there was a trend towards more cases in lower-income and marginalised populations, frostbite impacted all segments of society. Frostbite education initiatives involving patients and providers have the potential to positively impact patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>L\u2019engelure est une blessure li\u00e9e au froid qui comporte un risque important de morbidit\u00e9 fonctionnelle en raison d\u2019amputations possibles. Peu d\u2019\u00e9tudes se sont int\u00e9ress\u00e9es \u00e0 l\u2019\u00e9pid\u00e9miologie et \u00e0 la r\u00e9partition r\u00e9gionale des engelures. Nous d\u00e9crivons ici les caract\u00e9ristiques des patients atteints d\u2019engelures et leur trajectoire de soins en Ontario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>M\u00e9thodes:<\/jats:title>\n                    <jats:p>Les donn\u00e9es proviennent de l\u2019Institute for Clinical and Evaluative Sciences et concernent les adultes de 18 ans et plus ayant consult\u00e9 \u00e0 l\u2019urgence en Ontario entre le 1er janvier 2010 et le 31 d\u00e9cembre 2018. Les patients ont \u00e9t\u00e9 suivis afin d\u2019\u00e9valuer les r\u00e9admissions dans les 30 jours et les traitements additionnels dans les 180 jours suivant la premi\u00e8re consultation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>R\u00e9sultats:<\/jats:title>\n                    <jats:p>\n                      Au total, 5 311 patients ont consult\u00e9 pour un \u00e9pisode unique d\u2019engelure en Ontario. La majorit\u00e9 des cas concernaient des engelures des extr\u00e9mit\u00e9s, class\u00e9es comme non sp\u00e9cifi\u00e9es (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3 775) ou superficielles (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1 379), principalement chez des hommes \u00e2g\u00e9s en moyenne de 40 ans et pr\u00e9sentant peu de comorbidit\u00e9s. Les cas ont \u00e9t\u00e9 observ\u00e9s dans tous les quintiles de revenu et de marginalisation avec une tendance plus marqu\u00e9e dans les indices de marginalisation \u00e9lev\u00e9s de l\u2019Ontario (ONMARG). Une proportion plus grande de personnes en situation d\u2019itin\u00e9rance a \u00e9t\u00e9 relev\u00e9e parmi les engelures profondes (10%), comparativement aux engelures superficielles (4,4%) ou non sp\u00e9cifi\u00e9es (5,6%). La plupart des patients (75%) se sont pr\u00e9sent\u00e9s dans de petits ou moyens h\u00f4pitaux non universitaires. Une hausse des cas a \u00e9t\u00e9 observ\u00e9e durant les hivers extr\u00eamement froids de 2014 et 2015.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Les patients atteints d\u2019engelures ont surtout \u00e9t\u00e9 pris en charge dans de petits et moyens h\u00f4pitaux non universitaires, avec une incidence accrue lors des \u00e9pisodes de froid extr\u00eame. Bien qu\u2019une tendance \u00e0 une plus grande incidence dans les populations \u00e0 faible revenu et marginalis\u00e9es ait \u00e9t\u00e9 observ\u00e9e, l\u2019engelure touche toutes les couches de la soci\u00e9t\u00e9. Des initiatives de sensibilisation aupr\u00e8s des patients et des professionnels de la sant\u00e9 pourraient am\u00e9liorer les r\u00e9sultats cliniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/cjrm.cjrm_65_24","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T10:02:46Z","timestamp":1762768966000},"page":"174-181","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Understanding frostbite presentation and distribution of care in Ontario 2010\u20132018"],"prefix":"10.4103","volume":"30","author":[{"given":"Yousuf","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada"},{"name":"Department of Family Medicine, Dalhousie University, Saint John, NB, 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