What Data are Gathered in Mass-Casualty Incidents? A Scoping Review

Mass-casualty incidents (MCIs) are overwhelming events which generate a surge in casualties, exceeding local capacity and stressing emergency services. Significant mortality, morbidity, and economic impact is often caused. They attract responses from both local and international governmental and non-governmental medical responders. To improve professional standards and accountability, there has been much recent focus on record-keeping by teams in these contexts. This paper seeks to further understand what data are gathered and shared as a result of MCIs to outline current practice and help move towards improved minimum standards of documentation.

A structured database search and abstract screening process was conducted utilizing PRISMA guidelines for scoping reviews. Data were then collected from all papers identified. To ensure all relevant data were gathered, authors of each included study were contacted to clarify their approach to data collection for their work.

From 154 included manuscripts, 64 data categories were found and recorded, capturing MCIs over a period of 32 years located in 42 countries from all World Health Organization (WHO) global regions. Retrospective and contemporaneous data collection was equally prevalent. In-hospital or research team data collection was most common. The ten most common data categories collected were: number of injuries (94.8%), number of deaths (89.6%), injury type (81.2%), cause of injury (79.9%), age (63.0%), sex (63.0%), treatment (62.3%), severity of injury (61.7%), outcome of injury (59.1%), and investigations/treatments given (55.8%). Of the contactable authors, only 29 responded. Sixteen reported reviewing notes retrospectively or using follow-up patient interviews.

There was significant variety in what data were collected, who collected it, and how it was done. The most common data categories were descriptive pieces of information or related to demographics. Only one-half of papers discussed treatments given. Information on both prehospital care and longer-term rehabilitation was much less prevalent.Terrorism and shooting related MCIs were the largest by paper number. Predominantly made up of more recent MCIs in higher income countries, these findings potentially reflect more organized health care systems.Overall, data collection in MCIs is challenging and heavily reliant on retrospective analysis. Current practice lacks standardization. If professionalism and accountability for health care delivery in MCIs is to be improved, so must the methods of data collection and minimum standards of documentation.