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Int. J. Surg., Dec 16 2025, | https://doi.org/10.1097/JS9.0000000000004505 Effectiveness of hybrid emergency room system in patients with severe trauma: a systematic review and meta-analysis

Hongrye Kim ^{1 2 †}, Youngmin Kim ^{3 †}, Sebeom Jeon ³, Soon Ki Min ³, Jaeik Jang ³, Jayun Cho ³, Byungchul Yu ^{3 4}, Kang Kook Choi ^{3 4}, Gil Jae Lee ^{3 4}, Junepill Seok^{5 6 *}, Dong Keon Yon ^{7 8 *}, Wu Seong Kang ^{3 *}

¹Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea.
²Department of Neurosurgery, Chungbuk National University, College of Medicine, Cheongju, South Korea.
³Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, South Korea.
⁴Traumatology, Gachon University College of Medicine, Incheon, South Korea.
⁵Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, South Korea.
⁶Department of Thoracic and Cardiovascular Surgery, Chungbuk National University, College of Medicine, Cheongju, South Korea.
⁷Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
⁸Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.

^†Hongrye Kim and Youngmin Kim authors are contributed equally as the first authors.

^*Corresponding authors: correspondence to Junepill Seok, Dong Keon Yon or Wu Seong Kang

Abstract

Background:
The hybrid emergency room system (HERS) integrates computed tomography (CT), surgical, and interventional radiology capabilities within a single trauma resuscitation space. This all-in-one design aims to eliminate interdepartmental transfer delays and expedite life-saving interventions for severely injured patients.

Methods:
We conducted a systematic review and meta-analysis across MEDLINE/PubMed, EMBASE, and the Cochrane Library for studies published up to 16 September 2025, to evaluate the clinical impact of HERS compared to conventional emergency room (ER) workflows. HERS treatment was defined as a protocolized, integrated approach that enables simultaneous diagnosis and treatment through the co-location of CT, angiography, and surgical capabilities within a single resuscitation space. The primary outcome was in-hospital mortality. Secondary outcomes included time to CT, time to hemostatic intervention, and transfusion requirements.

Results:
Ultimately, 5 studies were included in this systematic review. Our study revealed a significant reduction in in-hospital mortality among patients treated in HERS (odds ratio [OR] = 0.57; 95% confidence interval [CI]: 0.41–0.78). HERS also significantly reduced the time from admission to CT (standardized mean difference [SMD] = —1.99; 95% CI:—2.12 to—1.86) and to initial hemostatic intervention (SMD = —1.01; 95% CI:—1.12 to—0.89). Red blood cell transfusion requirements were lower in the HERS group as well (SMD = —0.15; 95% CI:—0.27 to—0.02). However, substantial heterogeneity and risk of bias were identified, as all included studies were retrospective and conducted exclusively in Japan.

Conclusion:
HERS shows promising potential to improve trauma care outcomes by expediting diagnostics and therapeutic interventions. Nevertheless, the current evidence base is limited to retrospective studies from a single country. Further research—including prospective, multi-center studies and cost-effectiveness analyses—is warranted to support broader global implementation of HERS models.

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