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®.
12 affiliations
- 1Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Aachen, Germany. [email protected].
- 2Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany. [email protected].
- 3Emergency Medical Services, Rhine-Berg District, Department of Emergency Medical Services and Dispatch, Bergisch Gladbach, Germany. [email protected].
- 4Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Aachen, Germany.
- 5Aachen Institute for Rescue Management & Public Safety, City of Aachen and University Hospital RWTH Aachen, Aachen, Germany.
- 6Aachen Emergency Medical Services, Aachen, Germany.
- 7Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany.
- 8Emergency Medical Services, Fire Brigade Essen, Essen, Germany.
- 9Emergency Medical Services, Fire Brigade Mülheim an der Ruhr, Mühlheim an der Ruhr, Germany.
- 10Institute for Trauma Research of AUC - Academy for Trauma Surgery, Munich, Germany.
- 11Centre for Emergency Medicine, BG Klinikum Duisburg, Duisburg, Germany.
- 12Emergency Medical Services, Oberhausen Fire Brigade, Oberhausen, Germany.
Abstract
Background
Mass 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.Methods
Data from the TraumaRegister DGU® were analysed for patients treated in Germany between mid-2020 and 2023. Patients with severe trauma (Maximum Abbreviated Injury Scale; MAIS ≥ 3) were included. Mass casualty incident cases were identified based on registry documentation. A 1:4 matched cohort was performed using age group, injury pattern and traffic involvement as matching criteria. The primary endpoint was in-hospital mortality; secondary endpoints included prehospital time intervals, performed interventions, and transport strategies. An additional multivariable logistic regression was performed as a sensitivity analysis of the primary endpoint.Results
A 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).Conclusion
Mass 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® but should be interpreted in light of residual confounding and the observational study design.
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BibTeX
@article{breuer2026prehospital,
title = {{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®.}},
author = {Florian Breuer and Stefan K Beckers and Bastian Brune and Marcel Dudda and Thomas Franke and Rolf Lefering and Andre Nohl},
journal = {BMC emergency medicine},
year = {2026},
month = oct,
doi = {10.1186/s12873-026-01818-y},
url = {https://europepmc.org/article/MED/42907761},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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®.
AU - Florian Breuer
AU - Stefan K Beckers
AU - Bastian Brune
AU - Marcel Dudda
AU - Thomas Franke
AU - Rolf Lefering
AU - Andre Nohl
PY - 2026
DA - 2026/10/20
JO - BMC emergency medicine
DO - 10.1186/s12873-026-01818-y
UR - https://europepmc.org/article/MED/42907761
AB - Background Mass 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.Methods Data from the TraumaRegister DGU® were analysed for patients treated in Germany between mid-2020 and 2023. Patients with severe trauma (Maximum Abbreviated Injury Scale; MAIS ≥ 3) were included. Mass casualty incident cases were identified based on registry documentation. A 1:4 matched cohort was performed using age group, injury pattern and traffic involvement as matching criteria. The primary endpoint was in-hospital mortality; secondary endpoints included prehospital time intervals, performed interventions, and transport strategies. An additional multivariable logistic regression was performed as a sensitivity analysis of the primary endpoint.Results A 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).Conclusion Mass 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® but should be interpreted in light of residual confounding and the observational study design.
SN - 1471-227X
ER -