This paper forms a portion of work undertaken by Yunjing (Shirley) Qiu as part of her Bachelor of Nursing (Honours) degree at Griffith University. Shirely was supervised by Professor Julia Crilly, Dr Jamie Ranse, and Dr Peta-Anne Zimmerman.


Background: Mass-gathering events (MGEs) are commonly associated with a higher than average rate of morbidity. Spectators, workers, and the substantial number of MGE attendees can increase the spread of communicable diseases. During an MGE, emergency departments (EDs) play an important role in offering health care services to both residents of the local community and event attendees. Syndromic indicators (SIs) are widely used in an ED surveillance system for early detection of communicable diseases.

Aim: This literature review aimed to develop an understanding of the effect of MGEs on ED patient presentations with communicable diseases and their corresponding SIs.

Method: An integrative literature review methodology was used. Online databases were searched to retrieve relevant academic articles that focused on MGEs, EDs, and SIs. Inclusion/exclusion criteria were applied to screen articles. The Standard Quality Assessment Criteria for Evaluating Primary Research (QualSyst) assessment tool was used to assess the quality of included papers.

Results: Eleven papers were included in this review; all discussed the impact of an MGE on patient presentations with communicable diseases at EDs/hospitals. Most included studies used the raw number of patients who presented or were admitted to EDs/hospitals to determine impact. Further, the majority of studies focused on either respiratory infections (n = 4) or gastrointestinal infections (n = 2); two articles reported on both. Eight articles mentioned SIs; however, such information was limited. The quality of evidence (using QualSyst) ranged from 50% to 90%.

Conclusions: Limited research exists on the impact of MGEs on ED presentations with communicable diseases and related SIs. Recommendations for future MGE studies include assessing differences in ED presentations with communicable diseases regarding demographics, clinical characteristics, and outcomes before, during, and after the event. This would benefit health care workers and researchers by offering more comprehensive knowledge for application into practice.


Qiu, Y. S., Crilly, J., Zimmerman, P. A., & Ranse, J. The Impact of Mass Gatherings on Emergency Department Patient Presentations with Communicable Diseases Related to Syndromic Indicators: An Integrative Review. Prehospital and Disaster Medicine, 2020.