Investigation of Trauma Cases Presented to the In-Event Health Care Services in Mass Gatherings: A Systematic Review

Mass gatherings (MGs) are associated with increased healthcare demand and may pose a risk for mass casualty incidents if medical services are not adequately planned. Trauma presentations constitute an important component of medical encounters during MGs; however, evidence regarding trauma patterns and preparedness requirements remains fragmented.

The primary aim of this study was to examine rates of trauma-related presentations to in-event health care areas during MGs. Secondary aims were to identify trauma patterns across different event types, support planning of in-event health services and develop a practical checklist to assist trauma preparedness and response planning.

Following PRISMA guidelines, a systematic search was conducted across PubMed, Web of Science, and Scopus databases for studies published between 2015 and 2025. Articles were screened based on the PICOS framework, focusing on observational studies of MG participants exposed to trauma. Inclusion required the reporting of in-event healthcare data, while studies solely using hospital-based records or lacking trauma-specific metrics were excluded. Data were extracted using a standardized form to identify event characteristics, patient presentation rate (PPR), and transport to hospital rates (TTHR). The primary outcome was the incidence of trauma, while secondary outcomes included the identification of trauma subtypes (e.g., musculoskeletal, soft tissue).

The initial search yielded 382 articles. After removal of duplicates and exclusions, 18 relevant studies were included in the final synthesis. The proportion of trauma-related visits relative to all patients treated at in-event medical stations ranged from 11.7 to 81.7%. The highest trauma rate was reported at the European Youth Olympic Winter Festival (81.7%), whereas the Guadalajara International Book Fair reported the lowest (11.7%). Soft tissue injuries (13-42.3%) were the most prevalent across music and sporting events, followed by musculoskeletal injuries (3-35.7%). Events involving mosh pit behavior showed a distinct clustering of head and facial injuries (65%).

This review demonstrates that trauma-related presentations in MGs are highly heterogeneous and influenced by event type and participant behavior. Soft-tissue injuries constitute the majority of reported trauma cases, while endurance/open-course sports and high-energy music events show higher trauma burdens. These findings support event-specific medical planning and trauma preparedness for in-event healthcare services.