From fun to frostbite: Cutaneous cold injuries linked to nitrous oxide, the experience of a tertiary burn centre in the UK.

Abstract

The use of nitrous oxide (N₂O) as a recreational drug has increased in the United Kingdom and consequently, the associated injuries, including frostbite injury, have also increased. The aim of this study was to investigate the incidence, pattern of injury, and management of frostbite injuries secondary to nitrous oxide use in a regional burns centre. A retrospective cohort study was conducted of all adults referred to the Burns Centre at Wythenshawe Hospital in Manchester, UK, with nitrous oxide cannister-related contact frostbite injuries between 2014 and 2024. Data were obtained from the International Burn Injury Database, referral system, and electronic medical records. Outcome measures included demographics, injury pattern, management, and follow-up. Descriptive statistical analyses were performed. 44 patients sustained frostbite injuries secondary to recreational nitrous oxide use between January 2021 to October 2024. 75 % of patients were aged between 15 and 24 years with the average age being 21.3. All patients had a delayed presentation to the Emergency Department with the average time to assessment being 12 days. The mean total body surface area injured was 0.73 % (range 0.2-2 %). The medial thigh was the commonest site of injury (63.6 %). 26 (56.1 %) patients sustained full thickness frostbite injury. 21 patients were lost to follow-up, 1 required skin grafting, and the remaining 23 patients had an average healing time of 87.9 days. The recreational use of nitrous oxide has risen in recent years and so has the incidence of associated cold injuries. The patients are typically young, or even children; however, restricting the use and distribution of nitrous oxide is challenging. Greater emphasis needs to be placed on educating this age group to address this public safety concern. Additionally, national data collection would be useful in investigating the impact within the UK.