title: A systematic review of noncommunicable health issues in mass gatherings.
abstract: BACKGROUND
  The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.
  
  
  METHODS
  A systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.
  
  
  RESULTS
  Across all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.
  
  
  CONCLUSIONS
  The rate of noncommunicable health issues varies across events and very serious emergencies are rare.
authors.affiliation: 1 Department of Health Services Administration and Leadership, George Washington University, Washington, DC USA and Civil Defense Aviation, Mekkah Province, Kingdom of Saudi Arabia.
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Alquthami
authors.affiliation: 2 Department of Emergency Medicine and Health Policy, George Washington University, Washington, DC USA.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D000006:Abdomen, Acute / Q000628:therapy; D000846:Anniversaries and Special Events; D003441:Crowding; D004630:Emergencies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006261:Headache / Q000628:therapy; D006801:Humans; D014947:Wounds and Injuries / Q000628:therapy