Introduction: Frostbite is freezing of the tissue that mostly affects skin but also the underlying tissues. It results from prolonged exposure to temperatures below the freezing point of water (0°C). One of the many consequences of climate change is extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Although frostbite has been a known phenomenon for a long time, occurring as early as 5000 years ago, the exact incidence of frostbite is not known. This is partly due to variable internal (frostbite susceptibility, hydration status, protective garments) and external etiological factors (wind chill, precipitation, altitude), that never coincide all at the same time. Objectives: The objective was to compare the incidence rates of frostbite in the published studies that focused on frostbite incidence. Methods: Out of a total of 61 studies using the keywords “frostbite” and “incidence” on PubMed, we selected seven that dealt with frostbite incidence over 20 years. We briefly summarized and compared the results of the studies. Results: The comparison of the seven studies shows a great variability of frostbite incidence depending on the population, its size, and the method of data collection. Studies that included civilian populations have significantly lower frostbite incidence rates than studies focusing on individuals who are exposed to temperatures below 0°C for extended periods, such as mountaineers, military personnel, workers in cold storage houses or homeless people. The results highlight different incidence rates for different populations and indicate that retrospectively collected data are insufficiently comparable among studies. Frostbite incidence, expressed as the ratio of injured individuals to non-injured inhabitants, is only comparable in studies using the same methodology. Enhanced frostbite susceptibility is a confirmed fact and was generally not considered in most of the studies. Conclusions: Frostbite incidences of the included studies are insufficiently comparable to draw any conclusions on possible general frostbite incidence in a population. To enhance our ability to estimate or predict frostbite occurrences within the general population, establishing an international or national frostbite registry in high-risk countries could be helpful.

Introduction: Frostbite is a condition that mostly affects skin, but also the underlying tissues, resulting from prolonged exposure to temperatures below freezing point (-0.55°C). Although frostbite has been a known phenomenon for several millennia, the exact incidence of frostbite is not known. This is partly due to variable internal and external etiological factors. One of the many consequences of climate change are extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Severe cold injury can lead to deep frostbite with irreversible sequalae such as amputations. Objectives: The reviews objective is to compare data collection and incidence rates of frostbite in different studies and populations. Methods: Out of a total of 61 studies using the keywords "frostbite" and "incidence", 7 were selected that dealt with frostbite causes and incidence over 20 years. The studies results were briefly summarized and their conditions were compared. Results: Frostbite can damage tissue superficially or deeply, depending on its degree. The results of the seven studies show a great variation of frostbite incidence depending on population, its size, and method of data collection. Studies that include the entirety of the civilian population show significantly lower frostbite incidence rates than studies focusing individuals who are exposed to temperatures below -0.55°C for long periods of time, such as mountaineers, military personnel, or homeless people. Although cold injuries are rare, they are becoming increasingly problematic for individuals who are exposed to a cold environment for prolonged periods of time due to climate change. This includes homeless individuals, outdoor workers in cold regions, alpinists and persons with inadequate equipment. The results underline different incidence rates for different populations and show that retrospectively collected data are insufficiently comparable. Enhanced frostbite susceptibility in some individuals should also be considered in the future in order to estimate the frostbite incidence more accurately. Moreover, defining frostbite susceptibility in advance could prevent frostbite incidence in the future to some degree, especially in military operations in the cold and certain leisure activities (e.g. mountaineering). Conclusions: Frostbite poses a significant risk in cold regions and can lead to severe complications without adequate protection. To enhance our ability to predict frostbite occurrences within the general population, it is crucial to understand its incidence in relation to climatic factors. Establishing an international or national frostbite registry in high-risk countries could effectively guide preventive measures and safeguard individuals. This registry should encompass frostbite occurrences alongside contextual elements, such as freezing temperatures and cold exposure duration. Moreover, comprehensive weather conditions like wind chill, precipitation, humidity, and cloud cover must also be considered. When similar external conditions result in frostbite, investigating protective measures becomes pivotal. Furthermore, researching individual susceptibility to cold is essential to discern variations in frostbite vulnerability, especially for activities in cold environments.