ArticleBMC emergency medicine2026
Prehospital management and hospital outcomes of severely injured patients during routine civilian mass casualty incidents: a 1:4 matched cohort analysis of the TraumaRegister DGU
Article in BMC emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMass casualty incidents (MCIs) pose substantial challenges to prehospital emergency medical systems due to limited resources and the need for rapid prioritization. Evidence regarding the impact of routine civilian MCIs on the management and outcomes of severely injured patients remains limited. This study aimed to evaluate the influence of MCIs on prehospital care, transport strategies, and clinical outcomes compared with routine individual care.
methodsData from the TraumaRegister DGU
resultsA total of 65,152 patients were included, of whom 430 were treated during mass casualty incidents (MCIs). After matching, 423 MCI patients were compared with 1,692 controls. Patients treated during MCIs had slightly higher injury severity (Injury Severity Score (ISS) 24.8 vs. 20.3). Median total prehospital time was significantly longer in the MCI group (85 [IQR 67-100] vs. 67 [IQR 53-83] minutes; p < 0.001). Invasive interventions, including prehospital intubation (33.6% vs. 20.9%) and administration of tranexamic acid (32.1% vs. 15.0%) were more frequently performed in the MCI group. Helicopter emergency medical services (HEMS) transport was used more frequently (34.5% vs. 20.7%). In the matched cohort, in-hospital mortality did not differ significantly between groups (13.5% vs. 11.7%; p = 0.317). In an additional multivariable sensitivity analysis, MCI status was not significantly associated with in-hospital mortality (adjusted OR 1.19, 95% CI 0.77-1.85).
conclusionMass casualty incidents (MCIs) were associated with prolonged prehospital care and modified transport strategies. No statistically significant difference in in-hospital mortality was observed between MCI patients and matched controls. These findings describe outcomes among severely injured patients captured by the TraumaRegister DGU
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