Cold burn injuries in the United Kingdom: A five-year cohort study of patients presenting to a regional burn unit

Abstract

AimsTo assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. MethodsRetrospective cohort study of consecutive patients over a five-year period (2018-22). ResultsSixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n=28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer ‘challenge’ and nineteen (31.2%) were self-harm, of whom five (26.3%) were inpatients on a mental health ward at the time of injury. All ‘challenge’ and self-harm injuries were caused by aerosol. ‘Challenge’ injury patients were younger than those with self-harm (p=.007) and non-intentional injuries (p<.001). A greater proportion of self-harm injuries were in female patients compared to non-intentional injuries (p<.001). Median TBSA was 0.35% (IQR 0.3). Most burns were superficial partial-thickness (n=35, 56.5%), followed by deep-dermal (n=18, 29.0%), full-thickness (n=8, 12.9%), and superficial (n=1, 1.6%). The upper limb was most frequently affected (n=35, 56.5%). Aetiology and whether a non-intentional, ‘challenge’ or self-harm injury did not affect TBSA (p=0.776 & p=0.364) or depth (p=0.353 & p=0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range 7-45, IQR 22.75). Follow-up ranged from 1-173 weeks. ConclusionsThe incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or due to social media or peer ‘challenges’. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use.