{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:31:53Z","timestamp":1791401513505,"version":"4.3.3"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The Munich Oktoberfest is the largest Volksfest in the world, attracting more than 6 million visitors every year to the city of Munich and surroundings, posing challenges to healthcare providers. Since 2022, a CT has been installed on the festival site to decrease patient transport to emergency departments (EDs) and relieve EDs of a significant number of patients. The aim of our studies was to determine the economic impact of on-site CT on the healthcare system, both from a German and a U.S. perspective. Methods: A decision model was built using patient data from the Munich Oktoberfest. Two scenarios were investigated where patients with mild traumatic brain injuries were either scanned for intracranial hemorrhage (ICH) with CT on-site or brought directly to an ED for further investigation. Costs for patient transportation and CT scans were derived from German national reimbursement rates as well as U.S. Medicare data. Costs were calculated by diagnosis in the national currency. Results: In all scenarios, on-site CT scans were associated with reduced costs per patient (EUR 243 vs. EUR 908 in the German setting and EUR 438 vs. EUR 1635 in the international setting, as well as USD 160 vs. USD 403 in the U.S. setting). For the U.S. scenario, the proportion of ICH in the patient group, as well as the transport distance, had the strongest impact on average costs per patient. Conclusions: On-site CT scanning is a cost-reducing as well as clinically beneficial method for triaging patients at the Munich Oktoberfest.<\/jats:p>","DOI":"10.3390\/jcm14072375","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T02:50:16Z","timestamp":1743389416000},"page":"2375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Economic Evaluation of On-Site Computed Tomography at Major Events Using Data from the Munich Oktoberfest\u2014A German and U.S. Healthcare Perspective"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0380-726X","authenticated-orcid":false,"given":"Wilhelm","family":"Flatz","sequence":"first","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Bogner-Flatz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"Emergency Medical Service Authority\u2013Upper Bavaria, Government of Upper Bavaria, 80538 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-352X","authenticated-orcid":false,"given":"Dominik","family":"Hinzmann","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Department of Anesthesiology and Intensive Care Munich, TUM School of Medicine and Health, 80333 Munich, Germany"},{"name":"Emergency Medical Service Authority City of Munich and Greater Area, 80466 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bazarian J.","family":"Jeffrey","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Ricke","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanz","family":"Karl-Georg","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, TUM School of Medicine and Health, 80333 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-1952","authenticated-orcid":false,"given":"Wolfgang G.","family":"Kunz","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Mehrens","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,30]]},"reference":[{"key":"ref_1","unstructured":"Eymold, U. (2024, November 18). Oktoberfest. Historisches Lexikon Bayerns. Available online: https:\/\/www.historisches-lexikon-bayerns.de\/Lexikon\/Oktoberfest."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"143772","DOI":"10.1016\/j.scitotenv.2020.143772","article-title":"Effects of weather, air pollution and Oktoberfest on ambulance-transported emergency department admissions in Munich, Germany","volume":"755","author":"Ghada","year":"2021","journal-title":"Sci. Total. Environ."},{"key":"ref_3","unstructured":"Rank, M. (2024, October 07). Wiesn-Ambulanz Zieht Bilanz: Weniger Eins\u00e4tze Und Patienten\u2014Das War Der h\u00f6chste Gemessene Promillewert. M\u00fcnchner Merkur. Available online: https:\/\/www.merkur.de\/lokales\/muenchen\/oktoberfest\/promille-wiesn-ambulanz-zieht-bilanz-weniger-einsaetze-patienten-jugendliche-betrunken-93340807.html."},{"key":"ref_4","unstructured":"(2025, March 23). Aicher Ambulanz Union. Available online: https:\/\/aicher-ambulanz.de\/pressemitteilung-wiesn-2023-2\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.annemergmed.2008.08.021","article-title":"Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting","volume":"52","author":"Jagoda","year":"2008","journal-title":"Ann. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1067\/mem.2002.125782","article-title":"Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting","volume":"40","author":"Jagoda","year":"2002","journal-title":"Ann. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1056\/NEJMc2306490","article-title":"Mobile Computed Tomography at Munich Oktoberfest","volume":"389","author":"Flatz","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_8","unstructured":"Landeshauptstadt M\u00fcnchen RfAuW (2024, November 20). Auf Geht\u2019s zur Wiesn 2024\u2014Alle Neuerungen auf dem Oktoberfest auf einem Blick. Available online: https:\/\/www.oktoberfest.de\/informationen\/oktoberfest-news\/auf-gehts-zur-wiesn-2024-alle-wichtigen-neurungen."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s00117-024-01383-0","article-title":"Mobile computed tomography at the Munich Oktoberfest: From idea to implementation","volume":"64","author":"Flatz","year":"2024","journal-title":"Radiologie"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s15006-016-8148-6","article-title":"Emergency department management of mild traumatic brain injury in adults\u2014An evidence-based algorithmic approach","volume":"158","author":"Biberthaler","year":"2016","journal-title":"MMW Fortschr. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1038\/s41746-023-00798-8","article-title":"Deep learning based automatic detection algorithm for acute intracranial haemorrhage: A pivotal randomized clinical trial","volume":"6","author":"Yun","year":"2023","journal-title":"NPJ Digit. Med."},{"key":"ref_12","unstructured":"Kassen\u00e4rztliche_Bundesvereinigung_Kd\u00f6R_(KBV) (2024). Einheitlicher Bewertungsma\u00dfstab (EBM): 4. Quartal 2024, National Association of Statutory Health Insurance Physicians."},{"key":"ref_13","unstructured":"Zentrale_Abrechnungsstelle_f\u00fcr_den_Rettungsdienst_Bayern_GmbH_(ZAST) (2024). Kosten des Rettungsdienstes, Zentrale Abrechnungsstelle f\u00fcr den Rettungsdienst Bayern GmbH."},{"key":"ref_14","unstructured":"Medicare.gov (2024, November 21). Procedure Price Lookup, Available online: https:\/\/www.medicare.gov\/procedure-price-lookup\/."},{"key":"ref_15","unstructured":"Centers_for_Medicare_&_Medicaid_Services (2024, December 02). Ambulance Fee Schedule Public Use Files, Available online: https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/ambulance\/ambulance-fee-schedule-public-use-files."},{"key":"ref_16","unstructured":"Kassenarztliche Bundesvereinigung (2024, December 02). Einheitlicher Bewertungsma\u00dfstab. KBV. Available online: https:\/\/ebm.kbv.de\/index.xhtml."},{"key":"ref_17","unstructured":"Centers for Medicare & Medicaid Services (2024, December 02). Physician Fee Schedule. CMS, Available online: https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search?Y=0&T=0&HT=0&CT=2&H1=70450&C=100&M=5."},{"key":"ref_18","unstructured":"Zentrale Abrechnungsstelle fur den Rettungsdienst Bayern GmbH (2024, December 02). ZAST Onlineportal. ZAST. Available online: https:\/\/www.zastportal.de\/zast\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s13049-024-01262-6","article-title":"Risk factors for traumatic intracranial hemorrhage in mild traumatic brain injury patients at the emergency department: A systematic review and meta-analysis. Scand","volume":"32","author":"Yang","year":"2024","journal-title":"J. Trauma Resusc. Emerg. Med."},{"key":"ref_20","unstructured":"Wolin, J., and Friedman, M.S. (2024). EMS Mass Gatherings, StatPearls."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Spaepen, K., Cardinas, R., Haenen, W.A.P., Kaufman, L., and Hubloue, I. (2023). The Impact of In-Event Health Services at Europe\u2019s Largest Electronic Dance Music Festival on Ems and Ed in the Host Community. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043207"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2147\/OAEM.S25587","article-title":"Health care in a unique setting: Applying emergency medicine at music festivals","volume":"4","author":"McQueen","year":"2012","journal-title":"Open Access Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1080\/10903120390936518","article-title":"On-site physicians reduce ambulance transports at mass gatherings","volume":"7","author":"Grange","year":"2003","journal-title":"Prehospital Emerg. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1017\/S1049023X16001199","article-title":"Health Service Impact from Mass Gatherings: A Systematic Literature Review","volume":"32","author":"Ranse","year":"2017","journal-title":"Prehospital Disaster Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1017\/S1049023X24000256","article-title":"Glastonbury Festival: Medical Care at the World\u2019s Largest Greenfield Music Festival","volume":"39","author":"Bennett","year":"2024","journal-title":"Prehospital Disaster Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1017\/S1049023X18000821","article-title":"Prospective Evaluation of Point-of-Care Ultrasound at a Remote, Multi-Day Music Festival","volume":"33","author":"Prager","year":"2018","journal-title":"Prehospital Disaster Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1017\/S1049023X18001188","article-title":"On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years","volume":"34","author":"Turris","year":"2019","journal-title":"Prehospital Disaster Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2375\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:05:48Z","timestamp":1760029548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,30]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072375"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072375","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,30]]}}}