TOPLINE
Among patients with frostbite injuries treated in US emergency departments (EDs), 11.3% required serious ED disposition, including hospital admission, transfer, or observation. Adults aged 65 years or older had nearly eightfold higher odds of serious disposition than those aged 17 years or younger, whereas patients with social exposure had more than threefold higher odds of serious disposition.
METHODOLOGY
- Researchers conducted a retrospective analysis of National Electronic Injury Surveillance System (NEISS) data from 2005 through 2024, identifying 1096 frostbite-related ED cases corresponding to an estimated 42,054 cases nationally.
- Frostbite cases were identified using the diagnosis code "burn, not specified" and narrative searches for frostbite-related terminology. Injury mechanisms were categorized based on exposure type as environmental or unspecified cold, contact cold, recreational, occupational, social, travel-related, or alcohol/substance-related.
- Researchers assessed demographic characteristics, seasonality, anatomic distribution, and ED disposition. Serious ED disposition was defined as hospital admission, transfer, or observation, whereas nonserious disposition comprised discharge.
- The primary outcome was serious ED disposition.
- Secondary outcomes were frostbite seasonality, injury mechanisms, demographic characteristics, and anatomic distribution.
TAKEAWAY
- Overall, 11.3% of frostbite-related ED visits resulted in serious disposition, whereas 88.7% resulted in discharge from the ED. Frostbite injuries were most common among patients aged 18-34 years (28.1% of cases) or 0-17 years (24.1% of cases), and 61.6% of the frostbite cases involved male patients.
- Although frostbite injuries were most common among younger patients, serious ED disposition increased with age. Patients aged 65 years or older had nearly eightfold higher odds of serious disposition than those aged 0-17 years (odds ratio [OR], 7.91; 95% CI, 3.62-17.3).
- Male patients had nearly threefold higher odds of serious disposition than female patients (P < .001), with serious disposition occurring in 15.3% of male patients vs 5.1% of female patients.
- Social exposure was associated with more than threefold higher odds of serious ED disposition (OR, 3.57; 95% CI, 1.89-6.77) and the highest rate of serious outcomes (39.3%), despite representing only 5.2% of frostbite cases. Environmental cold (41.1% of cases) and contact cold (36.6% of cases) were the leading injury mechanisms, but contact-cold injuries were associated with lower odds of serious disposition (OR, 0.47; 95% CI, 0.27-0.81) than environmental exposure.
IN PRACTICE
"The findings support a conceptual distinction between exposure burden and clinical vulnerability: younger individuals account for a larger share of injuries, whereas older adults and socially exposed individuals are at greatest risk for serious outcomes," the authors wrote.
"Prevention efforts should, therefore, address both the environmental circumstances that produce frostbite and the social conditions that increase the likelihood of resource-intensive emergency department management," they added.
SOURCE
The study was led by Adam W. Potter, US Army Research Institute of Environmental Medicine, Natick, Massachusetts. It was published online on July 23, 2026, in The American Journal of Emergency Medicine.
LIMITATIONS
The study was limited by the NEISS surveillance system, which was primarily designed to capture consumer product- and recreation-associated injuries and may have underrepresented frostbite from ambient environmental exposure. Frostbite was identified partly through a nonspecific diagnosis code, creating potential for misclassification. Serious ED disposition was used as a proxy for healthcare resource utilization and did not directly reflect frostbite tissue depth or biological severity. In addition, NEISS narratives inconsistently captured comorbidities and social circumstances, and changes to NEISS narratives and variables in 2019 may have affected mechanism classification.
DISCLOSURES
The study was funded by the Defense Health Agency. The authors reported having no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.