Unveiling Patient-Level Harms and At-Risk Clinical Groups During Hospital Cyberattacks: Systematic Review of Global Case Studies and Social Media Data.

Background: Cyberattacks against health care organizations are rising in frequency and shifting in nature from data theft to intentional denial of care. Objective: This systematic review identifies and characterizes patient-level harms occurring during hospital cyberattacks across international settings, determines which clinical populations are most vulnerable, and compares patient-level harms reported in peer-reviewed case studies with those described in patient and provider narratives on social media. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Search), and the SWiM (Synthesis Without Meta-analysis) reporting guidelines, we searched MEDLINE, Embase, PubMed, Scopus, and Web of Science for peer-reviewed studies published between January 1, 2004, and July 1, 2026 describing cyberattacks affecting clinical care in health care delivery organizations. Quantitative synthesis was not performed because the included studies reported structurally incompatible outcome types for which no common effect measure existed; synthesis without meta-analysis was conducted according to SWiM. In parallel, a Python (Python Software Foundation) pipeline mined 3408 health care-related subreddits for cyberattack terms extracted during the academic review; posts were reviewed by clinical team members to ensure relevance and coded to clinical specialties and technical failure domains. Results: Fifty-nine studies were included, from which 316 patient-level harms were identified across the combined datasets. Two distinct categories of at-risk patients emerged: those harmed by time-criticality, including patients with stroke, cardiac arrest, and major trauma, for whom delays of minutes to hours are clinically decisive; and those harmed by the intersection of digital dependence and potential for rapid clinical decline, including patients with cancer, patients with diabetes, and those dependent on community prescribing. Specific technical failures were linked to distinct clinical consequences, including those stemming from (1) hardware (oncological harms due to compromised linear accelerators), (2) software (risks for patients with fractures due to failures in digital templating software), and (3) networks/connectivity (fetal deaths due to telemetry failures). Social media data exposed wider harms resulting from infrastructural issues, including compromised door access systems preventing life-saving treatment, failures in ward-based alarms, and closed-circuit television (CCTV) affecting staff/patient safety, and disrupted health-at-home services preventing community therapies. Conclusions: Our study is the first to systematically integrate global case study evidence with large-scale social media data to provide a clinically focused synthesis of patient-level harms during health care cyberattacks. The resulting open-source Cyberattack Impacts, Patient Harms & Emergency Response (CIPHER) dataset links technical failure domains to downstream clinical risks across care settings. As cyberattacks on health care organizations continue to rise in frequency and severity, the boundary between cybersecurity and patient safety has become increasingly blurred, demanding unified frameworks that treat digital resilience and clinical preparedness as inseparable expressions of the same obligation to patients.