Defence Medical Services, RAF Leeming Medical Centre, Northallerton, UK.
Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
BMJ Mil Health. 2020 Oct;166(5):324-329. doi: 10.1136/jramc-2018-001099. Epub 2019 Mar 2.
Non-freezing cold injury (NFCI) occurs when peripheral tissue is damaged by cold exposure but not to the extent of freezing. Historically, the phenotype of NFCIs sustained was severe, whereas today the spectrum of injury represented in the UK military predominantly comprises subtler injuries. The diagnostic challenge of recognising these injuries, both in the acute and chronic settings, can lead to mismanagement and subsequent morbidity.
We characterised a recent case series of 100 UK Service Personnel referred with suspected NFCI to a Military UK NFCI clinic. We characterised the acute and chronic phenotype of those diagnosed with NFCI (n=76) and made comparison to those who received alternate diagnoses (n=24), to find discriminatory symptoms and signs.
The most common acute symptoms of NFCI were the extremities becoming cold to the point of loss of feeling for more than 30 min (sensitivity 96%, specificity 90%, p<0.001), followed by a period of painful rewarming (sensitivity 81%, specificity 67%, p<0.001). In-field foot/hand inspections took place in half of the NFCI cases. Importantly, remaining in the field and undergoing multiple cycles of cooling and rewarming after an initial NFCI was associated with having double the risk of the NFCI persisting for more than a week. The most common and discriminant chronic symptoms and signs of NFCI were having extremities that behave differently during cold exposures (sensitivity 81%, specificity 75%, p<0.001) and having abnormal pinprick sensation in the affected extremity (sensitivity 88%, specificity 88%, p<0.001).
A small collection of symptoms and signs characterise acute and chronic NFCIs and distinguish this vasoneuropathy from NFCI mimics.
非冻结性冷伤（NFCI）是指外周组织在寒冷暴露下受损但未达到冻结程度。历史上，NFCI 持续的表型较为严重，而如今英国军队中所代表的损伤谱主要是更微妙的损伤。在急性和慢性环境中识别这些损伤的诊断挑战可能导致管理不当和随后的发病率。
我们对 100 名因疑似 NFCI 而转介至英国军事 NFCI 诊所的英国军人的近期病例系列进行了特征描述。我们对被诊断为 NFCI（n=76）的患者的急性和慢性表型进行了特征描述，并与接受其他诊断（n=24）的患者进行了比较，以找到有区别的症状和体征。
NFCI 的最常见急性症状是四肢变得冰冷，感觉丧失超过 30 分钟（敏感性 96%，特异性 90%，p<0.001），随后是一段疼痛的复温期（敏感性 81%，特异性 67%，p<0.001）。在一半的 NFCI 病例中进行了现场足部/手部检查。重要的是，在初始 NFCI 后留在现场并经历多次冷却和复温循环与 NFCI 持续超过一周的风险增加两倍有关。NFCI 的最常见和最具区别性的慢性症状和体征是在寒冷暴露下四肢表现不同（敏感性 81%，特异性 75%，p<0.001）和受影响的四肢有异常刺痛感（敏感性 88%，特异性 88%，p<0.001）。
一小部分症状和体征可用于描述急性和慢性 NFCI，并将这种血管神经病与 NFCI 模拟区分开来。
