Nutritional Risk in Frostbite

Introduction: People with frostbite are often unhoused with a history of substance use which can increase the risk of malnutrition. We sought to evaluate malnutrition risk and incidence in those with frostbite admitted to our facility. Methods: Medical records of adults admitted with frostbite in 2019-2021 and with stays >4 days were reviewed. Data included housing status, substance use and nutritional status. Results: A total of 42 patients met inclusion criteria. Most had stable housing (69% housed; 31% unhoused). Alcohol (33%) and drug use (29%) were common in both groups. Three patients were at high risk for malnutrition (self reported weight loss); 31 denied weight loss and 8 did not know. Five patients (12%) received a more focused nutritional assessment but only three (all with reported weight loss) met criteria for malnutrition. Conclusions: We did not identify malnutrition often in this population. The paucity of reported pre-admit weight loss suggest that this risk factor may have limited use to screen for malnutrition. Contrary to published reports, few patients had malnutrition risk factors reported on admission. Reliance on self-reported weight and intake may obscure risk and presents an opportunity for more focused screening in our patients.

Nutritional Risk in Frostbite Caran Graves, MS, RDN, CNSC, Callie M. Thompson, MD, FACS, FABA, Christopher LaChapelle MD, DPT, Irma D. Fleming MD, Giavonni M. Lewis, MD, FACS, FABA Nutrition Care Services/University of Utah Burn Center Goal: Evaluate nutritional risk factors and incidence of malnutrition in adults hospitalized with frostbite • • • • • • Unhoused people are at risk for malnutrition Unhoused people are also at risk for frostbite Malnutrition risk unknown in patients with frostbite Retrospective chart review of patients admitted to a regional burn center between the years of 2019-2021 Identified patients using ICD codes T33, T34 Collected data related to housing status, substance use history, and nutritional risk factors RESULTS • • • • CONCLUSIONS 42 patients met inclusion criteria Most were housed with funding 19% with reported nutritional risk factor on admission Only 12% with a documented malnutrition evaluation • • • Many patients with frostbite are unhoused with substance use history Few have documented risk factors for malnutrition on admission Current malnutrition and diagnosis tools may under-identify those at risk APPLICATION TO PRACTICE Consider incorporating housing status in malnutrition risk screening Table 2. Patient History and Hospital Interventions by Housing Status Housing Status Housed Unhoused Weight Loss Reported, N 4 1 Nutritional Risk Factors 8 (19%) 1 (8%) Present, N (%) Nutritional Interventions, % Oral Intake 100% 100% Enteral Nutrition 14% 8% 79% 92% Vitamin Supplements References 1. Homelessness & Health: National Health Care for the Homeless Council. 2019 2. The 2002 Annual Homelessness Assessment Report (AHAR) to Congress 3. Cidass et al. J Burn Care Res 2023 4. Endorf, Nygaard. J Burn Care Res 2021 2. White et al. J Parent Enteral Nutr. 2012;36:275-283 Funding: No external funding