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Frostbite of the face and ears: epidemiological study of risk factors in Finnish conscripts

BMJ 1995; 311 doi: (Published 23 December 1995) Cite this as: BMJ 1995;311:1661
  1. E Lehmuskallio, medical chief Institute of Military Medicine, Finnish Defence Forces, Mannerheimintie 164, 00300 Helsinki, Finlanda,
  2. H Lindholm, research fellowa,
  3. K Koskenvuo, surgeon generalb,
  4. S Sarna, associate professor in statisticsc,
  5. O Friberg, senior researchera,
  6. A Viljanen, head of army departmenta
  1. aSantahamina Military Health Centre, POB 6, 00861 Helsinki, Finland
  2. b Medical Section, Finnish Defence Staff, POB 919, 00101 Helsinki, Finland
  3. c Department of Public Health, University of Helsinki, POB 21, 00014 Helsinki, Finland
  1. Correspondence to: Dr Lehmuskallio


    Objective:To determine the incidence of and the risk factors for local cold injuries of the face and ears in peacetime military service

    Design:Prospective, controlled epidemiological study using a questionnaire

    Setting:Finnish defence forces, 1976-89

    Subjects:913 young male conscripts with local frostbite of the head that needed medical attention and 2478 uninjured control conscripts

    Main outcome measures:Type of activity, clothing, and other risk factors at the time of cold injury. Odds ratios were used to calculate risk. Controls were handled as one group.

    Results:The mean annual incidence of frostbite was 1.8 per 1000 conscripts. Frostbite of the ear was most common (533 conscripts (58%)), followed by frostbite of the nose (197 (22%)) and of the cheeks and other regions of the face (183 (20%)). Most conscripts (803 (88%)) had mild or superficial frostbite. Risk factors included not wearing a hat with earflaps (odds ratio 18.5 for frostbite of the ear); not wearing a scarf (odds ratio 2.1 and 3.8 for frostbite of the ear and cheeks respectively); using protective ointments (odds ratio 3.3, 4.5, and 5.6 for frostbite of the cheeks, ear, and nose respectively); being extremely sensitive to cold and having hands and feet that sweat profusely (odds ratio 3.5 for frostbite of the nose); and being transported in the open or in open vehicles under windy conditions (odds ratio 2.2 for frostbite of the cheek).

    Conclusion: Wearing warm clothing, including a scarf and a hat with earflaps, helps to prevent frostbite. Each person's sensitivity to cold may also be important. The routine use of protective ointments should not be recommended.


    • Funding Scientific Committee of National Defence, Finland.

    • Conflict of interest None.

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