Road safety and road traffic accidents in Saudi Arabia. A systematic review of existing evidence

Healthcare human resource development in Saudi Arabia: emerging challenges and opportunities-a critical review

Background

Saudi Arabia is currently passing through a transformational phase. There is a huge demand on the Saudi healthcare system to provide better healthcare facilities to the rapidly increasing Saudi population, as well as the growing elderly population. Lack of trained healthcare professionals and heavy reliance on foreign workers are significant aspects for policymakers to consider and deal with. It is also important to re-examine the healthcare Human Resource Development (HRD) initiatives so as to provide a huge reserve of healthcare professionals with appropriate learning and competence.

Method

This paper is a critical review based on secondary data collected from various sources including databases, reports, articles, books, government documents and earlier research undertaken in this regard. The paper is an attempt to document and evaluate the various steps suggested and undertaken by the new strategic plan, Vision 2030, and consequently documented in the National Transformation Program (NTP) adopted in April 2016 in the healthcare HRD sphere in Saudi Arabia.

Results

It has been shown that appropriate HRD capacity building needs to be adopted along with the aggressive policy regulation. It is also important to ensure that future health sector investment meets the needs of local healthcare HRD. Saudization and the adoption of the ‘Nitaqat’ program have played an effective role in pushing the Saudization targets in the private sector, and there is a huge scope for the absorption of young trained Saudi boys and girls in the healthcare sector.

Conclusion

Vision 2030 adopted in 2016 is a testimony to a revolutionary step undertaken by the government and that the healthcare sector is also passing through a major shift in its approach and execution. Vision 2030 has come out with a very clear sense of direction to the healthcare sector, and the projected shift from the existing one-third to two-third Saudi-to-foreigner workforce ratio by the year 2030 needs to be adopted carefully to turn the healthcare HRD challenges into opportunities.

Identifying developmental trajectories of worldwide road traffic accident death rates using a latent growth mixture modeling approach

Road Traffic Accidents (RTA) are a major worldwide public health problem. The aim of this study was to use the growth mixture model for clustering countries on the basis of the mortality rate patterns of RTAs from 2007 to 2013. We obtained the data on RTA death rates from World Health Organization reports and Human Development Index (HDI) of United Nations Development Programme reports for the years 2007, 2010 and 2013. Simple Latent Growth Models (LGM) in 181 countries were applied to estimate overall RTA mortality rate growth trajectories and the latent growth mixture modeling utilized to cluster them. According to non-linear LGM, the overall mortality rate of RTAs showed a decrease from 2007 to 2010 followed by an increase from 2010 to 2013. The HDI covariate had a significant negative and positive effect on intercept and slope of the LGM, respectively. The extracted mixture model appeared to have seven classes with different trends in RTA mortality rates. The worldwide countries were clustered into seven classes. Further studies on each of the seven classes are suggested to provide recommendations for reducing the mortality rate of the RTAs. Additionally, increasing HDI in some countries could have a significant effect on reducing the RTA death rates.

Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study

Background/Aim

Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM).

Methods

A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05.

Results

Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively).

Conclusion

Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.

Frequency and Nature of Road Traffic Injuries: Data of More than 10,000 Patients from Ha'il, Saudi Arabia

Background Road traffic accidents (RTAs) have become a major issue in today's world. They have caused the loss of more than a million lives in the last decade and are substantially increasing every day. Injuries due to RTAs can cause significant morbidity and mortality. These injuries can be sorted by the type, body region, gender, and age group. We aimed to highlight the frequency and nature of road traffic injuries (RTIs) according to these variables in Ha'il, the Kingdom of Saudi Arabia. Methods A retrospective study was conducted in King Khalid Hospital, Ha'il. Data on the cases of RTIs were collected, which presented to the hospital emergency department from January 1, 2016, to December 31, 2017. Data analysis was then performed using IBM Statistical Package for the Social Sciences 17.0 (SPSS, IBM, NY, USA). Frequencies were calculated using descriptive statistics, and graphs were generated. Results A total of 10,855 patients with RTIs were encountered at the hospital emergency department. Out of these, 8035 patients were males (74.02%) while 2820 were females (25.97%). Fractures of one or more sites were the most common type of injury, encountered in 5173 patients (47.66%). Lacerations occurred in 3487 patients (32.12%). Crush injuries were encountered in 1190 patients (10.96%) while penetrating injuries occurred in 844 patients (7.78%). Abdominal and pelvic visceral injuries were present in 103 patients (0.95%) while thoracic visceral injuries were present in 39 patients (0.36%). Amputations occurred in 19 patients (0.18%). Conclusion Our study highlights the frequency and nature of road traffic injuries that present in the emergency department. As suggested by the high frequency of specific types of injuries, special training should be provided to healthcare professionals to address and treat fractures, head and neck injuries, and serious lacerations effectively.

Awareness of fitness to drive among cardiologists in Saudi Arabia

OBJECTIVES

To assess the perception and awareness of cardiologists in Saudi Arabia about medical fitness to drive in different cardiovascular diseases. Methods: The study is a cross-sectional survey-based study between June 2018 and July 2018. Cardiologists were asked to complete a self-administered questionnaire inquiring about awareness of driving fitness and educating patients regarding driving risks in specific cardiovascular conditions. Results: A total of 194 cardiologists completed the study survey; there were 30.4% consultants, 59.3% specialists, and 10.3% residents. Out of 195, 72% were aware of the existence of particular international driving regulations for cardiovascular diseases, whereas 28% were not aware. Although, no Saudi guidelines assessing fitness-to-drive are available, 11% of the participants claimed awareness of such regulations. Interestingly, we found that cardiologists had never or rarely educated their patients regarding the potential risks of driving: 49% in symptomatic angina, 47% when ejection fraction is ≤35%, 39% in symptomatic valvular diseases, 26% after cardioverter defibrillators implantation, and 23% after non-elective percutaneous coronary interventions. Conclusion: There is a lack of awareness among cardiologists in Saudi Arabia about international guidelines regarding medical driving fitness. This study highlights the necessity of formulating appropriate national driving regulations for cardiovascular diseases.

The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi national survey for elderly Health (SNSEH)

PURPOSE

First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA.

METHODS

This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12 months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period.

RESULTS

Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02-3.99). Antidepressants (RR = 1.72; 95%CI: 1.10-2.74), laxatives (RR = 1.38; 95%CI: 1.11-1.7), low body mass index (RR = 1.94; 95%CI: 1.33-2.84), mild cognitive impairment (RR = 1.56; 95%CI: 1.21-2.03), high door steps (RR = 1.54; 95%CI: 1.23-1.93) and insufficient illumination (RR = 1.38; 95%CI: 1.11-1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years.

CONCLUSION

Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA.

Diagnostic accuracy of Focused Assessment with Sonography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia

Objectives:

To determine the diagnostic accuracy of Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma caused by motor vehicle accidents at our Hospital in Dhahran city.

Methods:

This descriptive, observational study was conducted in the Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia between September 2016 and September 2017. All adult patients (n=105) involved in motor vehicle accidents with blunt abdominal injury on presentation were retrospectively reviewed for FAST and CT scans for detection of free fluid. Focused assessment with sonography for trauma studies were conducted or supervised by senior registrar of general surgery (trauma team leader). Computed tomography findings were reviewed by 2 experienced radiologists. High and low-grade solid abdominal visceral (liver, spleen, kidney) injuries were identified on CT scans. Focused assessment with sonography for trauma and CT scan findings were identified as ‘positive’ and ‘negative’ for presence and absence of free fluid respectively. Outcomes of FAST were presented on a 2x2 contingency table.

Results:

Sensitivity of FAST in detecting intraperitoneal free fluid was calculated as 76.1% (95% confidence interval [CI], 64.14-85.69%), specificity 84.2% (95% CI, 68.75-93.98%) and accuracy 79% (95% CI, 70.01-86.38%). Focused assessment with sonography for trauma detected free fluid in most cases of high-grade solid visceral injuries. Nearly half of true-negative cases were having low grade visceral or other injuries.

Conclusion:

Focused assessment with sonography for trauma is an important tool in initial assessment of suspected blunt abdominal injury patients with high sensitivity and specificity. A negative FAST does not exclude low grade solid visceral or other injuries.

Substance abuse at early age as a potential risk factor for driving under the influence of substance in Jeddah, Saudi Arabia: A cross-sectional study

OBJECTIVE

Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors.

METHODS

This is a cross-sectional survey conducted between May and September 2016 at Al-Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pretested questionnaire to collect data regarding sociodemographic and socioeconomic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment, and fatalities under the influence of an abused substance. Whenever possible, we compared self-reported data with medical records and resolved any conflict by discussion with the patient.

RESULTS

A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused (56.4% [n = 57] and 25.7% [n = 26] of patients, respectively). As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate regression (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.75-0.99; P = .046) but not the multivariate regression (OR =0.87; 95% CI, 0.75-1.00; P = .056), a younger age at the time of the first substance abuse was associated with a higher probability of driving under the influence of an abused substance.

CONCLUSIONS

Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addition to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.

Diabetes and driving recommendations among healthcare providers in Saudi Arabia. A significant gap that requires action

Objectives:

To assess healthcare providers’ knowledge and awareness of the recommendations for drivers with insulin-treated diabetes in Saudi Arabia.

Methods:

A cross-sectional study was conducted among healthcare providers working at 4 tertiary hospitals in Riyadh, Saudi Arabia between April 2016 and December 2016 using a self-administered questionnaire.

Results:

A total of 285 healthcare providers completed the survey (response rate 88.5%). Most (70.2%) were aware of the safe driving recommendations for patients with insulin-treated diabetes. However, the need to check blood glucose levels before driving was underestimated by almost one-third (30.2%). Only one-quarter (24.6%) identified the correct level of blood glucose level that is safe for a patient when driving, and 28.4% identified the recommended time for checking blood glucose before driving. Participants who were aware of the recommendations for safe driving had a significantly higher average knowledge score (68.8%) than those who were not aware (58.8%; p<0.001). There was a significant difference in the average knowledge score among medical specialties (p=0.002) and job levels (p<0.001).

Conclusions:

Most healthcare providers identified the importance of evaluating their patients for ability to drive safely, but we found some important areas of knowledge deficit. Professional intervention to improve healthcare providers’ awareness and knowledge regarding diabetes and driving is the first step in improving detection and reporting high-risk drivers with diabetes to prevent future driving mishaps.

Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015

BACKGROUND

Peripheral nerve injury (PNI) as an adjunct lesion in patients with upper extremity trauma has not been investigated in a Central European setting so far, despite of its devastating long-term consequences. This study evaluates a large multinational trauma registry for prevalence, mechanisms, injury severity and outcome characteristics of upper limb nerve lesions.

METHODS

After formal approval the TraumaRegister DGU® (TR-DGU) was searched for severely injured cases with upper extremity involvement between 2002 and 2015. Patients were separated into two cohorts with regard to presence of an accompanying nerve injury. For all cases demographic data, trauma mechanism, concomitant lesions, severity of injury and outcome characteristics were obtained and group comparisons performed.

RESULTS

About 3,3% of all trauma patients with upper limb affection (n = 49,382) revealed additional nerve injuries. PNI cases were more likely of male gender (78,6% vs.73,2%) and tended to be significantly younger than their counterparts without nerve lesions (mean age 40,6 y vs. 47,2 y). Motorcycle accidents were the most frequently encountered single cause of injury in PNI patients (32,5%), whereas control cases primarily sustained their trauma from high or low falls (32,2%). Typical lesions recognized in PNI patients were fractures of the humerus (37,2%) or ulna (20,3%), vascular lacerations (arterial 10,9%; venous 2,4%) and extensive soft tissue damage (21,3%). Despite of similar average trauma severity in both groups patients with nerve affection had a longer primary hospital stay (30,6 d vs. 24,2 d) and required more subsequent inpatient rehabilitation (36,0% vs. 29,2%).

CONCLUSION

PNI complicating upper extremity trauma might be more commonly encountered in Central Europe than suggested by previous foreign studies. PNI typically affect males of young age who show significantly increased length of hospitalization and subsequent need for inpatient rehabilitation. Hence these lesions induce extraordinary high financial expenses besides their impact on health related quality of life for the individual patient. Further research is necessary to develop specific prevention strategies for this kind of trauma.

Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015

BACKGROUND

Peripheral nerve injury (PNI) as an adjunct lesion in patients with upper extremity trauma has not been investigated in a Central European setting so far, despite of its devastating long-term consequences. This study evaluates a large multinational trauma registry for prevalence, mechanisms, injury severity and outcome characteristics of upper limb nerve lesions.

METHODS

After formal approval the TraumaRegister DGU® (TR-DGU) was searched for severely injured cases with upper extremity involvement between 2002 and 2015. Patients were separated into two cohorts with regard to presence of an accompanying nerve injury. For all cases demographic data, trauma mechanism, concomitant lesions, severity of injury and outcome characteristics were obtained and group comparisons performed.

RESULTS

About 3,3% of all trauma patients with upper limb affection (n = 49,382) revealed additional nerve injuries. PNI cases were more likely of male gender (78,6% vs.73,2%) and tended to be significantly younger than their counterparts without nerve lesions (mean age 40,6 y vs. 47,2 y). Motorcycle accidents were the most frequently encountered single cause of injury in PNI patients (32,5%), whereas control cases primarily sustained their trauma from high or low falls (32,2%). Typical lesions recognized in PNI patients were fractures of the humerus (37,2%) or ulna (20,3%), vascular lacerations (arterial 10,9%; venous 2,4%) and extensive soft tissue damage (21,3%). Despite of similar average trauma severity in both groups patients with nerve affection had a longer primary hospital stay (30,6 d vs. 24,2 d) and required more subsequent inpatient rehabilitation (36,0% vs. 29,2%).

CONCLUSION

PNI complicating upper extremity trauma might be more commonly encountered in Central Europe than suggested by previous foreign studies. PNI typically affect males of young age who show significantly increased length of hospitalization and subsequent need for inpatient rehabilitation. Hence these lesions induce extraordinary high financial expenses besides their impact on health related quality of life for the individual patient. Further research is necessary to develop specific prevention strategies for this kind of trauma.

Patterns of injuries and predictors of inhospital mortality in trauma patients in Saudi Arabia

Background

The aim of this study was to describe the pattern of traumatic injuries and determine the predictors of inhospital mortality in patients admitted to the emergency department.

Patients and methods

This is a retrospective cohort study of 3,786 patients with traumat injuries admitted to the emergency department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 2012 and December 2014. Data on patient characteristics, trauma characteristics and outcomes were extracted from medical records. A negative binomial regression model was utilized to identify significant predictors of inhospital mortality.

Results

Of all injured patients, 77.5% were male, 29.8% were aged 15-25 years and 25.7% were aged 26-45 years. Blunt trauma was the main mechanism of injury, including motor vehicle crashes (MVCs) in 52.0% and falls in 25.8% of patients. Most patients had injuries to the extremities (61.3%), followed by the head (32.2%), chest (16.9%) and abdomen (8.9%). Injuries were mild in 49.7% of patients, moderate in 30.2% and severe in 20.1%. The sex of the patients was significantly associated with the mechanism of injury (p<0.001), severity (p<0.001), anatomical site of injury (p<0.001), admission to the intensive care unit (p<0.001), need for trauma team activation (p<0.001) and type of transportation to hospital (p<0.001). The predictors of inhospital mortality were age (rate ratio [RR] for each 10-year increase=1.174; p<0.001), falls and burns (RR=2.337 and 1.728; p<0.001) and moderate and severe injuries (RR=6.438 and 181.780; p<0.001).

Conclusion

Our results suggest different patterns of trauma injuries according to patient age and sex. MVCs were the leading cause of injuries, but falls and burns had the highest inhospital mortality. This suggests the need for a comprehensive national education and prevention programs that address all causes of injuries.

Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia

Background

Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide.

Aim

This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU).

Design and Methods

A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions.

Results

Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p < 0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p < 0.05).

Conclusion

Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.

Patterns of injury detected by pan-computed tomography after road traffic accidents: retrospective review from a trauma center in Saudi Arabia

BACKGROUND

Pan-scan (whole-body) computed tomography (CT) has a paramount role in the diagnosis of injuries in road traffic accidents (RTA).

OBJECTIVE

Identify patterns of injuries on pan-CT scans.

DESIGN

Retrospective medical record review.

SETTING

Tertiary care center.

PATIENTS AND METHODS

The records of all RTA patients who presented to the radiology department at King Fahad Military Medical Complex (KFMMC) in Dhahran for the 3-year period from July 2014 to July 2017 and underwent pan-CT were retrospectively reviewed. Drivers and front-seat passengers with complete clinical information on seating, safety and mechanism of injury were selected. Children under 5 years of age, pregnant women and back-seat passengers were excluded. Patterns of injuries were categorized as 'no abnormality detected' (NAD), isolated or combined head, face and neck (H), isolated or combined chest, abdomen and pelvis (C) or both regions of the body (B).

MAIN OUTCOME MEASURES

Injury patterns on pan-CT scans.

SAMPLE SIZE

305 RESULTS: Most patients were males (n=287, 94.1%). The median age was 26 years for males (IQR, 22-33 years) and 30 years for females (IQR, 28-39). More than two-thirds were drivers (all males); the remainder were front-seat passengers. Young males were most often involved. The most common type of accident was a roll-over. Of those who sustained injuries, 273 (89.5%) were not wearing a seat belt (unrestrained). The patterns of injuries were NAD (87, 28%), H (27, 9%), C (93, 30.5%), B (98, 32%).

CONCLUSION

When abnormalities were detected, most high-speed vehicular injuries affected the torso. Unrestrained young male drivers are most often involved in RTAs in Saudi Arabia.

LIMITATIONS

Retrospective study with a small sample size. Types and severity of injuries on pan-CT were not documented.

CONFLICT OF INTEREST

None.

Smart Road Traffic Accidents Reduction Strategy Based on Intelligent Transportation Systems (TARS)

Traffic accidents have become an important problem for governments, researchers and vehicle manufacturers over the last few decades. However, accidents are unfortunate and frequently occur on the road and cause death, damage to infrastructure, and health injuries. Therefore, there is a need to develop a protocol to avoid or prevent traffic accidents at the extreme level in order to reduce human loss. The aim of this research is to develop a new protocol, named as the Traffic Accidents Reduction Strategy (TARS), for Vehicular Ad-hoc NETworks (VANETs) to minimize the number of road accidents, decrease the death rate caused by road accidents, and for the successful deployment of the Intelligent Transportation System (ITS). We have run multiple simulations and the results showed that our proposed scheme has outperformed DBSR and POVRP routing protocols in terms of the Message Delivery Ratio (MDR), Message Loss Ratio (MLR), Average Delay, and Basic Safety Message.

Post traumatic cervical anterolithesis: comprehensive evaluation and expert opinion

This case report details the case of a 31-year-old male clerk who complained of widespread pain that significantly limited his daily work. The patient underwent some physical therapy sessions, but unfortunately, the results were unsatisfactory. An expert in the field with distinguished experience was called to evaluate the patient using a new systematic approach. Comprehensive whole body evaluation was conducted using a total assessment-reassessment & evaluation using biokinesiologic (TAREK) approach. This approach is aimed at guiding physical therapists and rehabilitation professionals in conducting comprehensive evaluations, particularly for complex neuromusculoskeletal cases. The expert used the TAREK approach to address the patient; persistent symptoms. The systematic approach not only enables comprehensive evaluation but also guides junior therapists in implementing physical therapy interventions. The study suggests that complex neuromusculoskeletal cases need to be thoroughly evaluated by highly trained therapists using the systematic approach.

Total assessment-reassessment & evaluation using bioKinesiologic (TAREK) approach: case presentation for theoretical formulation

[Purpose] To introduce a new systematic physical therapy evaluation aiming to facilitate the process of examining complicated musculoskeletal cases. [Subject and Methods] The patient was a 20 years old male college student who had major motor vehicle accident one year ago. The patient was poorly responding to physical therapy and he felt that his case was worsening. The complexity of the case dictated a new evaluation with a different approach to resolve the barriers hindering the patient from showing functional improvements. [Results] The new evaluation approach explained many undetermined and stubborn symptoms experienced by the patient. The expert confirmed that the traditional evaluations methods utilized were insufficient to address patient’s complaints. [Conclusion] Total Assessment-Reassessment & Evaluation using bioKinesiologic (TAREK) approach is comprehensive evaluation strategy using systematic pathway that guides clinicians to pinpoint the contribution of pathoanatomical structures in producing pathomechanical mobility and poor functional outcomes.

Associated head injuries and survival rate of patients with maxillofacial fractures in road traffic accident: A prospective study in Saudi Arabia

Background:

Every minute, an accident occurs in Saudi Arabia, causing 39,000 injuries and 7,000 deaths annually. Facial trauma or maxillofacial trauma (MFT) is a frequent presentation of road traffic accidents (RTAs), ranging from simple nasal fractures to gross or severe maxillofacial injuries.

Methods:

A total number of 237 patients were included in this prospective study from May 2013 to January 2018. The following medical details were recorded for each case, gender, age, fracture location, the presence of scalp laceration, the presence of brain damage, type of brain damage, shock degree, Glasgow Coma Scale (GCS), number of units used for blood transfusions for documentation of patient survival rate. We followed up the patients in their first appointment after 21 days of patient discharge from the hospital.

Results:

Majority of the patients were young male adults. A total of 59.1% of patients had cerebral damage, 38% (n = 90) of patients had at least, one scalp laceration, 43.5% (n = 103) of patients had some degree of shock, whereas 27.8% of the recruited patients needed at least 1 unit of blood transfusion. A total of 14.3% of the patients died as a result of their injuries, and the survival rate was 85.7%.

Conclusions:

Kingdom of Saudi Arabia (KSA) is having a high incidence of RTAs leading to high mortality rate. Therefore, it requires a sound evaluation of the risk factors for RTAs and establishment of guidelines to decrease the incidence of road traffic injuries and reduce health-care burden. Road safety campaigns focused on young population can help reduce RTAs and subsequent mortalities. Prompt arrival at the hospital, early diagnosis, and timely management of maxillofacial fractures and brain damages by skilled physicians will lower mortality rate in KSA..

Mobile phone use while driving and the risk of collision: A study among preparatory year students at King Saud University, Riyadh, Saudi Arabia

OBJECTIVES:

The objectives of this study were to determine the rate of mobile phones use while driving by the students of King Saud University, Riyadh, Saudi Arabia, their perception of the risks, and contribution to collisions.

MATERIALS AND METHODS:

A cross-sectional study was conducted in May 2014 targeting 986 male students of King Saud University, Riyadh, Saudi Arabia. A questionnaire was used to obtain data on possessing a driving license, years of driving experience, driving hours, and collision or near misses in the 6 months preceding the study. Eight statements were used to assess the behavior and perceptions related to the use of mobile phones while driving. Data were analyzed using the Chi-square statistic, odds ratio, and the 95% confidence interval.

RESULTS:

Almost half of the participants (45.3%) had driving experience of 4–6 years and 18.3% of them did not possess a driving license. Collision in the preceding 6 months was reported by 44.6% of participants, and 37.9% of them attributed these collisions to mobile phones. Variable proportions reported that they always texted (53.3%) or talked on a handheld (66.2%) or hands-free (26.1%) phones while driving. A higher proportion conceded that there were hazards in texting (77.0%) and speaking on handheld mobile phones (83.9%) rather than hands-free (35.9%) while driving. The risk increased significantly from 2.052 among participants who reported that they drove daily for 1–2 h to 3.165 of those who reported that they drove for more than 6 h. No significant risk was observed in relation to participants' perceptions, age, driving experience, and possession of a driving license.

CONCLUSIONS:

There was a risk of collision with the use of handheld and hands-free mobile phones. As hands-free mobile phones are no safer, national legislation should consider restricting their use by drivers and implementing legislations to reinforce safety on the roads. An objective assessment of the contribution of mobile phones to road traffic injuries is recommended.

Using Growth Mixture Modeling for Clustering Asian and North African Countries on the Road Injury Death Trend (1990-2010)

OBJECTIVES

The physical injuries and financial implications as a result of road accidents have serious economic, cultural, and social effects. We conducted this study to determine any changes in the trend of road-accident-related deaths in Asian and North African countries from 1990 to 2010.

METHODS

The current study was carried out using data from the Global Burden of Disease database. First, the process was assessed using the growth curve divided into six regions. Moreover, the classification was done based on the death rate using growth mixed modeling.

RESULTS

The road injury death trend for men had more variations than women. Classification of these countries based on mortality using the latent growth mixture model resulted in more homogeneous classes according to trend in road fatalities. Disregarding gender and sex, there were four optimal classes. The first three classes had a decreasing trend with the third class having the greatest decreasing trend. South Korea and Taiwan were in this group. Afghanistan, Indonesia, Thailand, Iran, the UAE, Saudi Arabia, and Oman lay in group 4 and had an increasing trend in road injury deaths.

CONCLUSIONS

Successful interventions that developed countries have used to avoid casualties of road injuries could be used in developing countries. These include passing laws making the use of seatbelts and child seats compulsory and determining appropriate speed limits.

Assessment of patients' medical fitness to drive by primary care physicians: A cross-sectional study

OBJECTIVES

Motor vehicle collisions (MVCs) are a significant health burden in Saudi Arabia. The literature has consistently indicated that chronic medical conditions, such as diabetes, heart disease, stroke, obstructive sleep apnea, and neurodevelopmental disorders, increase the risk of MVCs. Therefore, assessment of driver fitness by primary care physicians (PCPs) remains a major health intervention that might reduce MVCs. We studied the practices of PCPs in assessing medical fitness to drive in at-risk patients.

METHODS

We conducted a cross-sectional study of all 88 government-funded primary care centers in the city of Riyadh, Saudi Arabia. We administered a self-reported questionnaire to PCPs that inquired about their driving risk assessment for specific medical conditions.

RESULTS

Among all PCPs and centers, 189 PCPs (63%) from 74 centers (84%) participated in our survey. The mean age of the PCPs was 40 ± 10 years, and 108 (57%) were men. The average clinical experience of the group was 13 ± 9 years. Fewer than half of PCPs considered diabetes mellitus (45%) and obstructive sleep apnea (46%) as potential risks for MVCs. Approximately 45% of PCPs did not notify any authority or relatives of potential driving issues that they noticed in their patients. Only 15% of the participants believed that PCPs were responsible for alerting authorities about their fitness to drive.

CONCLUSIONS

PCPs did not adequately assess their patients' driving history and eligibility. Efforts are needed to improve awareness among PCPs regarding the effects of chronic medical conditions on driving.

Pattern of Injuries from Road Traffic Accidents Presented at a Rural Teaching Institution of Karachi

The aim of the study is to study the pattern of injuries from road traffic accidents presented at the emergency department of a rural teaching institution in Karachi. This descriptive case series was conducted prospectively in the Emergency Department of Fatima Hospital and Baqai Medical University from 1 January 2012 to 21 March 2013. There were 385 patients in the series. All of the patients with recent injuries from road traffic accidents were included. Cases with injuries more than 72 h old were excluded. The majority of patients had lower limb injuries 172 (44.7%), followed by head and neck injuries 107 (27.8%), multiple injuries 62 (16.1%), upper limb injuries 22 (5.7%), abdominoperineal injuries 19 (5%), and chest injuries 3 (0.8%). Majority (229, 59.5%) of patients were given first aid treatment and discharged, while 151 (39.3%) patients were either admitted or referred to better equipped hospitals. Three patients were brought dead, and two patients left against medical advice. The lower limb injuries were the commonest road traffic accidental injuries, followed by head and neck injuries, multiple injuries, upper limb injuries, abdominoperineal injuries, and chest injuries.

Youth traffic-related injuries: a prospective study

Background

Traffic-related injuries are the most common cause of morbidity and mortality of the youth. Our aim was to study epidemiology, risk factors and outcome of hospitalized youth patients injured in road traffic collisions in order to give recommendations for prevention.

Methods

We prospectively studied all youth (15–24 years) patients having traffic-related injuries who were admitted to Al Ain or Tawam Hospitals, Al Ain City, or who died after arrival to these hospitals during an 18 months period. Demography, location and time of injury, injured body regions, severity, hospital and intensive care unit (ICU) stay and outcome were analyzed.

Results

Three hundred thirty-three patients having a mean age (SD) of 20 years (2.5) were studied. 87% were males and 72% were UAE nationals. Majority of injured patients were drivers or front-seat passengers (70%), followed by back seat passengers (16%), motorcyclists (5%) and pedestrians (4%). Rollover was the most common crash mechanism (35%), followed by front crash (34%). Twenty seven patients (8%) were ejected during the crash, 14 during roll-over, 7 from quadribikes and three during front crash. 20% of the patients were admitted to the ICU. Median Glasgow Coma Scale was 15 (range 3–15), median Injury Severity Score was 5 (range 1–41), and median total hospital stay was 3 days (range 1–73). Nine (3%) patients died.

Conclusions

Young UAE-national males are at a higher risk of being injured at traffic. Rollover crash was frequent with high risk of ejection. Promotion of traffic safety and enforcement of safety legislation is necessary.

Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia

BACKGROUND

Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia.

OBJECTIVE

To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system.

DESIGN

Retrospective, analytical.

SETTING

Trauma center of a tertiary care center in Riyadh.

PATIENTS AND METHODS

The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods.

MAIN OUTCOME MEASURE(S)

Injury severity score (ISS), Glasgow coma scale (GCS) and mortality.

RESULTS

The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant.

CONCLUSIONS

This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs.

LIMITATIONS

The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.

Ilizarov bone transport after massive tibial trauma: Case report

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Successful unifocal tibial lengthening of 14.5 cm without using intramedullary nail guide.

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Bone transport demands high compliance from the patient to achieve optimal results.

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Bone transport proves to be an excellent alternative in managing massive bone loss.

Introduction

This is a case report of extreme lengthening of the tibia of about 14.5 cm using bone transport technique following road traffic accident trauma to the lower limbs. The management of the subsequent massive skeletal defects was challenging to orthopedic surgeons. Based on reported cases, the highest tibial lengthening was 22 cm using bifocal transport, while the highest unifocal tibial lengthening reached 14.5 cm.

Case presentation

A 20-year-old male driver was brought to the emergency department after a road traffic accident. The patient had a right Gustilo IIIA segmental open tibia fracture with bone loss and other severe injuries. The tibial defect was 14.5 cm and the patient was then admitted for Ilizarov application six months after the accident. Although this case was particularly complicated, full limb length was restored.

Discussion

The management of this case was directed to correct the deformities and achieve equal length of both limbs to restore the normal function. Several new techniques have been developed recently to fill large bone defects. Limb lengthening using bone transport technique by application of Ilizarov ring fixator has been suggested as the leading option in filling massive bone gaps.

Conclusion

The use of bone transport technique using Ilizarov external rings has proved to be a minimally invasive and reliable method in managing massive bone defects. Accurate application of the Ilizarov frame and proper transport of the middle segment are important factors alleviating the risk for deviation of the transported segment. However, due to the need for regular follow-ups and monitoring, it demands high compliance from the patient to achieve optimal results.

Attitudes and behaviors towards risky driving among adolescents in Saudi Arabia

Background and Objectives

The main objective of the paper is to investigate perceptions and attitudes of school youth concerning risky driving behaviors (i.e.: Tafheet) in Saudi Arabia.

Design and Setting

This was a school-based cross-sectional study of adolescents in Riyadh that employed a multistage probability sampling scheme.

Subjects and Methods

The self-administered survey included questions adapted from the school-based studies conducted by the Centers for Disease Control and Prevention in the United States. The survey inquired about adolescents' behaviors and attitudes toward driving, perceptions of school and family, and leisure time activities.

Results

Nearly 40% of the students surveyed reported engaging in the risky driving behavior called Tafheet. Fifty-one percent of those who engage in dangerous activities also reported engaging in Tafheet. A higher proportion (70%) among those who believe Tafheet is a talent or a cool activity also engaged in Tafheet. Multivariate analyses indicate that students who are willing to engage in dangerous activities even when they are known to be dangerous (OR = 2.7; 95% CI = 1.55–4.72), those who think there is no harm in not wearing seat belts are at higher speeds (OR = 2.77; 95% CI = 1.24–6.21), and those who use a mobile telephone while driving are nearly three times (OR = 2.96; 95% CI = 1.41–6.23) at risk for engaging in Tafheet. Lack of respect towards traffic laws is also a risk factor.

Conclusion

Our study unequivocally points to pro-attitudes and behavior including a daring personality, not wearing a seat belt and using a mobile telephone while driving are significant factors associated with risky driving activity. Our study calls for a strategic intervention plan to change the culture of risky driving through a structured and stringent driving curriculum in school settings. A curriculum of this nature is currently non-existent in the Kingdom of Saudi Arabia (KSA). Multilevel and multifaceted interventions may hold great promise in reducing unintended motor vehicle injuries and changing the culture as a whole.