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

Rising trend in traffic accident mortality in Iran after a decade of decline (2006-2022): time to raise the alarm

BACKGROUND

This study examines epidemiology and trend of mortality rates due to traffic accidents in Iran from 2006 to 2022.

METHODS

Data were collected from the Iranian Legal Medicine Organization and the Statistical Center of Iran. Age-standardized mortality rates were calculated using direct standardization. A Latent Class Growth Mixture Model (LCGMM) was employed to evaluate trends and identify provinces with similar patterns.

RESULTS

From 2006 to 2022, Iran recorded 325,851 traffic accident deaths, with a median age of 34 years; 78.8% were male. Most deaths occurred on intercity roads (63.84%, n = 208,021), followed by urban roads (27.73%, n = 90,365) and rural roads (7.63%, n = 24,859). Mortality rates declined significantly from 38.86 per 100,000 in 2006 to 19.85 in 2017 but increased to 23.00 per 100,000 in 2022, underscoring a concerning public health issue. A reverse J-shaped trend was identified nationally using LCGMM, showing an initial decline (intercept: 48.13, SE = 1.32; slope: -3.67, SE = 0.34) followed by a significant upward trend (quadratic term: 0.14, SE = 0.02, p < 0.001). The quadratic term's highly significant p-value highlights the importance of this non-linear pattern. At the provincial level, six distinct mortality trend classes were identified, highlighting significant regional variations. Most provinces exhibited a reverse J-shaped pattern, except Sistan and Baluchestan and Kohgiluyeh and Boyer-Ahmad, which showed U-shaped trends.

CONCLUSION

After a decade of decline (2006-2017), Iran's traffic fatalities resurged post-2017, potentially linked to economic strain, aging vehicle fleets, and inconsistent enforcement of safety regulations. Targeted interventions -subsidies for safer vehicles, infrastructure upgrades, and regional policies- are urgently needed to reverse this trend and align with global road safety goals.

Trend of Injury Severity and Road Traffic-Related Mortality in an Arab Middle Eastern Country: A 12-Year Retrospective Observational Study

Background: Road traffic injuries (RTIs) significantly contribute to disability and death in Qatar. This observational study aimed to explore RTI mortality and injury severity trends from 2011 to 2022. Methods: Data from the national trauma database were analyzed retrospectively for mortality rates, injury severity, and characteristics of the injured populations over the years (2011-2022). Results: RTIs represented around 61.3% (n = 12,644) of 20,642 trauma hospitalizations over 12 years. The aggregate RTI mortality rate decreased from 12 to 8 per 100,000 persons, with a mean patient age of 31.8 years. The sum of deaths was 2464, comprising 1022 (41%) in-hospital and 1442 (59%) out-of-hospital fatalities. Among in-hospital deaths, bike-related mortalities totaled 35 (3%), motorcycle-related mortalities 53 (5%), motor vehicle mortalities 561 (55%), and pedestrian mortalities 373 (36%). Based on the injury severity score (ISS), RTIs were divided into four categories, namely, mild (ISS: 1-9), moderate (ISS: 10-15), severe (ISS: 16-24), and fatal (ISS: 25-75). The ISS ranged from 12 to 14, while the median ranged from 10 to 12. The injury frequency showed that mild injuries comprised 40.6% (4545), moderate injuries 26.2% (2934 subjects), and severe 16.7% (1873 subjects). Profound injuries accounted for 13.3% (1490 subjects). Severe and fatal injuries combined dropped from 30% in 2011 to 25% by 2022. Inversely, moderate injuries increased from 24% to 30%, representing a downward trend of the injury severity. Motorcycle-related injuries rose from around 3% to 28% between 2011 and 2022. Motor vehicle and pedestrian injuries declined from about 67% to 54% and 27% to 15%, respectively. Winter, Autumn, Spring, and Summer accounted for 27%, 26%, 24%, and 23% of the total injuries (11,153), respectively. Conclusions: RTI in-hospital mortality and injury severity decreased over the study period. Injury prevention programs should target frequent injury seasons and high-risk populations, such as motorcyclists.

Advancing Health Through Sustainable Development Goals-Saudi Arabia's Mid-Journey Progress and Insights

A critical component of Saudi Arabia's Vision 2030 reform agenda is its alignment with the Sustainable Development Goals (SDGs), particularly SDG 3, which is dedicated to the promotion of health and well-being for all. This narrative review offers a mid-term assessment of Saudi Arabia's progress in attaining these objectives, with a particular emphasis on the public health initiatives and comprehensive healthcare reforms that have been implemented as part of this vision. The Kingdom has accomplished substantial reductions in maternal and neonatal mortality rates, with skilled birth attendance reaching nearly universal levels. Saudi Arabia is a regional leader in the field of infectious diseases, having achieved the 95-95-95 HIV targets and significantly reduced the incidences of tuberculosis and malaria. Additionally, the rates of premature mortality from conditions such as cancer, diabetes, and cardiovascular diseases have decreased as a result of efforts to combat non-communicable diseases. Mental health services have been substantially expanded, which has resulted in one of the lowest suicide rates reported worldwide. Substantial investments have collectively improved the universality and quality of healthcare services in health infrastructure, such as the expansion of primary healthcare centers and the integration of digital health solutions, which have supported these health achievements. Saudi Arabia continues to confront persistent obstacles, including the management of the increase in non-communicable diseases, the mitigation of environmental health risks, and the reconciliation of healthcare access disparities, despite these accomplishments. The review recommends that the social determinants of health be addressed through a sustained commitment to cross-sectoral collaboration, enhanced data collection and utilization for health policy-making, and further integration of technology in healthcare delivery. This review not only emphasizes the Kingdom's successes but also the intricate challenges it has encountered, providing valuable insights into the strategic planning required to maintain health gains and achieve SDG 3 by 2030. Saudi Arabia's innovative approach and robust policy implementation serve as a model for the integration of health priorities into national development frameworks, thereby improving health outcomes and contributing to sustainable development.

Are Saudi Radiological Sciences Students Prepared for Emergencies? Exploring Knowledge, and Attitudes Towards Basic Life Support and Cardiopulmonary Resuscitation

Purpose

This study aims to evaluate the preparedness of Saudi radiological sciences students for emergencies by assessing their awareness of cardiac arrest evaluation criteria, knowledge of Cardiopulmonary Resuscitation (CPR) and defibrillators, and attitudes towards performing CPR.

Methods

A cross-sectional descriptive study was conducted among students from the radiological sciences program at three Saudi universities. Using a well-established questionnaire, the study employed non-probability convenient sampling. Descriptive statistics were generated, and chi-square test examined associations between categorical variables and Basic Life Support (BLS) training status.

Results

Out of 367 students contacted, 261 participated (71.1% response rate). BLS training markedly enhances knowledge of the correct chest compression rate, with 50.9% of trained students demonstrating accurate understanding compared to 27.5% of untrained students (P < 0.0001). A significant correlation was found between BLS training and the ability to perform cardiac massage during cardiac arrest and respiratory standstill, with 44.1% of students demonstrating this knowledge (P < 0.0001). Notably, 80.8% of students without BLS training lacked knowledge of cardiac massage, compared to only 30.4% of those with training. Additionally, 30.6% of students were familiar with defibrillators, and 44.1% knew AED locations (P = 0.0007). Hesitation to perform CPR was mainly due to fear of mistakes (53.6%) and harm concerns (31.1%).

Conclusion

Our findings reveal significant gaps in knowledge, confidence, and preparedness for cardiac emergencies among Saudi radiological sciences students, with only 41.4% having completed BLS training. These results highlight the urgent need for comprehensive BLS education to.

The Impact of Age Differences and Injury Severity on Pedestrian Traffic Crashes: An Analysis of Clinical Characteristics and Outcomes

Background/Objectives: The incidence of pedestrian traffic injuries is an escalating concern for public health worldwide. Particularly in fast-developing nations, such as Saudi Arabia, these injuries form a significant portion of trauma-related healthcare challenges. This study aims to explore age-specific differences in trends, seasonal variations, and the overall impact of pedestrian traffic injuries in Riyadh, Saudi Arabia, with a focus on injury characteristics and clinical outcomes. Methods: The study conducted a retrospective analysis using data from the Saudi Trauma Registry (STAR) covering the period between August 2017 and December 2022. It employed descriptive statistics, chi-square tests, and multivariable linear regression analyses to explore demographic trends, characteristics of injuries, and hospital-based outcomes. Results: This study analyzed data from 1062 pedestrian injury cases, revealing key demographic and clinical patterns. Most incidents occurred on weekdays (71.9%) and during nighttime hours (63.3%), with seasonal peaks observed from April to June (30.4%). The lower extremities (27.5%) and head (21.3%) were the most frequently injured body regions. ICU admissions were more common among individuals aged 30-40, females, and those with head or chest trauma, while higher in-hospital mortality was associated with patients over 60 years old, transport by private or police vehicles, and extended ICU and hospital stays. Approximately 25.6% of cases required ICU care, with an overall in-hospital mortality rate of 4.9%. Conclusions: This study provides an in-depth analysis of pedestrian traffic injuries treated at a trauma center in Riyadh, highlighting significant demographic, temporal, and clinical patterns. Understanding these trends is essential for optimizing resource allocation and improving emergency care outcomes. Furthermore, the identified age-specific risk factors and seasonal variations underscore the critical need for targeted interventions and policy enhancements to improve road safety and reduce the burden of pedestrian injuries.

Public Awareness Levels Regarding Cervical Spine Injury and the Suitable First Aid Response Among Adults in Makkah, Saudi Arabia

Purpose

Cervical spine injuries (CSIs) are a growing concern, leading to severe and permanent disabilities. Educating the public about these injuries and appropriate emergency responses is crucial to prevent irreversible damage, minimize disability, and save lives, especially with the rising number of trauma victims worldwide. Herein, we assessed the awareness of CSIs, trauma identification, and first-aid procedures among adults in Makkah, Saudi Arabia.

Sample and Methods

This descriptive cross-sectional study included 591 participants aged 18 or older from Makkah, Saudi Arabia, selected using an online questionnaire and conducted between January and March 2024. We evaluated participants' knowledge and awareness levels about CSIs, analyzing variables such as personal data and first aid training using descriptive statistics, cross-tabulation, and Pearson chi-square tests.

Results

In total, 318 (53.8%) participants demonstrated good awareness of CSIs. Most (76.5%) identified road traffic accidents as a significant risk factor for CSIs. Additionally, 476 (80.5%) participants recognized that CSIs can involve spinal cord damage. Motor disability was acknowledged by 434 (73.9%) participants as a complication linked to CSIs, while 296 (50.1%) and 224 (37.9%) participants recognized sensory disability and respiratory problems as potential associated complications, respectively.

Conclusion

Our findings show that 53.8% of participants had an acceptable awareness level of CSIs, with road traffic accidents identified as the primary cause of spinal injuries. It is crucial to prioritize regular and organized public education and enforce strict road safety measures, particularly among the young, to mitigate the extensive physical, social, emotional, and economic consequences of this issue.

Investigating the Burden of Traumatic Injuries and Access to Trauma Centers in Rural Riyadh

INTRODUCTION

Trauma is a major cause of death and disability among young adults in Saudi Arabia, with a road traffic fatality rate three times higher than other high-income countries. The vast expanse of the Riyadh region comprises 21 governorates over 156,078 square miles, most of which is rural. Although delays in access to trauma care pose a significant mortality and economic burden, regions at highest risk of delays have not been previously studied. This paper aims to identify the trauma center distribution, trauma burden, and areas with delayed access to trauma care in the rural governorates of the Riyadh region.

METHODS

We conducted a retrospective review of 24,268 reports from 17 rural governorates in the Riyadh region from the official data registry of the Red Crescent of Saudi Arabia from January 2021 to March 2023. Higher severity cases were classified under the red criteria (for age 15-64 ys: systolic blood pressure (SBP) < 90 mmHg or heart rate > SBP); for age ≥65 ys: SBP <110 mmHg or heart rate > SBP) based on established trauma activation criteria. We geospatially mapped all level 1-3 trauma centers in the rural governorates of the Riyadh region with an overlay of trauma burden, and identified red criteria cases and those that had delayed access to trauma centers in each of the governorates. Data were mapped using Quantum Geographic Information System, and analysis was performed using R statistics.

RESULTS

Rural Riyadh lacks level 1 trauma centers, with level 3 facilities primarily delivering trauma care. Among the reported trauma cases, majority were classified under the red criteria (67.7%, n = 16,433). Al-Kharj emerged as a hotspot for trauma cases, reporting the highest number of cases (21.4%, n = 5202) and red criteria cases (21.4%, n = 3512), followed by Al-Quwayiyah (14.4%, n = 3490) and Al-Majma'ah (9.8%, n = 2369). Blunt trauma predominated (79.4%, n = 19,280), with a substantial portion meeting the red criteria (62.4%, n = 12,032), while penetrating injuries were less common (14.5%, n = 3524). Of the red criteria cases, 38.2% (n = 6048) were delayed, most notably in Al-Kharj (21.8%, n = 1320).

CONCLUSIONS

In conclusion, our study reveals significant gaps in trauma care access and burden across rural governorates in the Riyadh region. The absence of level 1 trauma centers, coupled with high proportions of red criteria cases and delays in accessing care, underscores the need for targeted interventions and resource optimization. Addressing these challenges requires standardized trauma systems, improved transfer protocols, and a national trauma registry for comprehensive monitoring of patient outcomes.

Community Health Needs Assessment of Primary Healthcare in Saudi Arabia: A Cross-Sectional Study

Introduction

Continuous assessment of community health needs is essential to predict, recognize, and act on healthcare issues. Conducting community health needs assessments (CHNAs) in Saudi Arabia has become a priority to overcome the current healthcare challenges and keep pace with the Saudi Arabia 2030 vision. Studies reporting community health needs in Saudi Arabia regions are limited despite the high incidence of chronic diseases. This study aims to understand the community's health problems and the range of healthy behaviors and determine the priority health problems.

Methods

We conducted a cross-sectional study based on the adults in Primary Health Care Centers in Hail, Northern Saudi Arabia, by using the CHNA standard questionnaire. In addition to the demographic information, the questionnaire collects data on personal health status, the health status of adults and children, health facilities access information, receiving of healthcare procedures, traveling for healthcare, source of medical information, safety measures and behaviors, health problems, childcare (special needs), and perceived community problems.

Results

In all, 336 individuals were approached to participate in this study; 303 agreed to participate (response rate: 90%). The analysis comprised 276 individuals after eliminating 27 who did not fulfill the age inclusion criteria or had missing gender data. Of these, 107 (38.8%) were men and 169 (61.2%) were women. Our data revealed that almost half of the participants, 135 (52.9%) constantly or 107 (42%) occasionally, were able to visit the doctors when needed.

Conclusion

Our findings reported positive health behaviors and good accessibility to healthcare services when needed. However, the study findings also revealed healthcare challenges that required urgent action from Hail healthcare leaders. Developing healthcare strategies, screening/prevention programs, and changing healthcare policies in the Hail region are needed to control and prevent health problems and improve the population's health.

The Impact of Intoxication on the Prognosis of High-Speed Motor Vehicle Accidents: A Tertiary Care Center Experience

Introduction

Several studies suggest a causal link between psychoactive agents and motor vehicle accidents (MVA). This study aimed to evaluate the impact of substance abuse and alcohol intoxication on the prognosis of high-speed MVA victims.

Methods

This is a single-center retrospective cross-sectional study involving adult multiple trauma cases who were admitted to the emergency department for high-speed MVA and underwent toxicological screening. The cohort was conducted based on two main outcomes; the survival status and the neurological outcomes.

Results

894 patients with the mean age of 27.8 ± 9.24 (range:18-37) years were studied (97.9% male). The most common indicators of severity were car rollover and ejection from the car. 296 of the patients had severe traumatic brain injury (TBI). 622 of the patients had a positive toxicological screening, with benzodiazepines (51.2%) and alcohol (26.6%) being the most commonly abused substances. The mortality rate was 5.8% and 12.1% of the patients had unfavorable neurological outcomes upon discharge. On multivariate logistic regression, predictors of mortality among high-speed MVA victims were report of a death at the scene (adjusted odds ratio (aOR): 2.529; 95% confidence interval (CI): 1.026-6.232; p = 0.044), severe TBI, the presence of dilated pupils (aOR: 11.074; 95% CI: 1.293-94.812; p = 0.028), hypotension (aOR: 0.456; 95% CI: 0.227-0.916; p = 0.027), and hypoxia (aOR: 2.95; 95% CI: 1.46-5.95; p = 0.003). Predictors of unfavorable neurological outcomes were report of a death at the scene (aOR: 3.133; 95% CI: 1.445-6.791; p = 0.004), positive toxicology screening (aOR: 3.30; 95% CI:1.68-10.204; p = 0.038), severe TBI, the presence of hypoxia (aOR: 2.96; 95% CI:1.645-5.319; p = 0.000), hypotension (aOR: 0.437; 95% CI: 0.252-0.758; p = 0.003), and bleeding (aOR: 0.287; 95% CI: 0.164-0.501; p < 0.001).

Conclusion

A concerning proportion of high-speed MVA victims had a positive toxicology screening. Although intoxication did not increase mortality of high-speed MVAs, it was a significant predictor of unfavorable neurological outcomes of survivors.

Epidemiology and Prevalence of Musculoskeletal Disabilities Following Motor Vehicle Accidents in Aljouf Region, Saudi Arabia

Background and Objectives: Motor vehicle accidents (MVAs) are the leading cause of disability, particularly among young adults in Saudi Arabia. Persistent disabilities account for around 7% of all injuries attributed to MVAs in Saudi Arabia in the last twenty years. Limited studies on musculoskeletal disabilities following MVAs have been carried out in Saudi Arabia. This study aims to explore the epidemiology and prevalence of musculoskeletal disabilities in motor vehicle accident (MVA) patients in the Aljouf region, Saudi Arabia. Materials and Methods: This retrospective cross-sectional study evaluated all MVA victims treated in the Aljouf region, Saudi Arabia, from January 2020 to December 2022. A total of 3252 medical records were collected, with 731, 1197, and 1324 musculoskeletal injury cases per year, of which 88, 168, and 153 records from 2020, 2021, and 2022 were analysed, respectively. Results: The study found that patients aged 25-34 and 35-44 years were the most likely to experience disability following MVAs. The difference between age groups during a single year was statistically significant (p < 0.001). Most patients were male (89.8%, 82.7%, and 79.7%) during 2020, 2021, and 2022, respectively. The majority of injuries involved the upper extremities (38.6%, 36.9%, and 40.5%), followed by lower extremities (36.4%, 35.7%, and 34.6%), head and neck (21.6%, 26.2%, and 34.6%), thoracic region (20.5%, 24.4%, and 17%), and finally lumbosacral spine (6.8%, 5.4%, and 6.5%) during 2020, 2021, and 2022, respectively, with a significant difference for each year (p < 0.001). The study found a link between the likelihood of developing high disability grades and injury severity scores. The patients with very severe ISS ≥ 25 (OR: ∞ CI 95%: 39.81-∞; p < 0.001), severe ISS = 16-24 (OR: ∞ CI 95%: 20.90-∞; p < 0.001), and moderate ISS = 9-15 (OR: ∞ CI 95%: 1.2-∞; p = 0.02) were at greater risk of developing high grades of disability. Conclusions: This study highlighted the musculoskeletal disabilities in the Aljouf region following MVAs. Severe musculoskeletal disabilities were rare, but fractures were the most common following MVAs. More efforts should be directed towards education on early transportation and transfer to the nearest medical centres, seeking assistance immediately after MVAs for patient safety, and disability prevention.

The Level of Knowledge and Attitude Toward Dealing With Fractures at Accident Sites Among Al Baha Population

BACKGROUND

A fractured bone is a medical emergency that causes bone continuity to be partially or completely disrupted. Effective fracture management at accident sites is crucial for minimizing complications and improving outcomes. Despite its importance, this study aimed to assess the level of knowledge and attitude toward fracture management among residents of Al Baha province and explore the association of this knowledge with demographic factors.

METHODOLOGY

A cross-sectional descriptive study involving 389 participants was carried out employing a structured online self-administered questionnaire that contained sociodemographic information about the participants along with a basic knowledge assessment regarding fractures at accident sites. To investigate relationships between variables, statistical analysis was used, including the Chi-square test.

RESULTS

This investigation revealed a majority of participants demonstrated moderate to high levels of knowledge about fracture management, with 166 (42.7%) classified as having high knowledge and 187 (48.1%) as having moderate knowledge. Meanwhile, four (1%) were found to have poor levels. Significant associations were found between knowledge levels and gender (p = 0.048), residency (p = 0.014), and marital status (p = 0.011). Males, residents of Al Baha, and married individuals showed the highest levels of knowledge. However, gaps were identified in responses related to open fractures and spine injuries.

CONCLUSION

In conclusion, a study of 389 participants highlights a generally high level of knowledge about fracture management among Al Baha residents, with notable differences linked to demographic factors. While the findings suggest a solid understanding of basic fracture management principles, there are specific areas where knowledge could be improved. Targeted educational interventions, especially those addressing identified knowledge gaps and tailored to different demographic groups, are recommended to enhance public preparedness and response to fractures.

The Impact of Climate Change on Road Traffic Crashes in Ghana

Despite the substantial injuries and fatalities from Road Traffic Crashes (RTCs), evidence of climate change's impact on RTCs in Ghana is lacking. This study assessed the impact of climate change on RTCs in Ghana by combining quantitative (Mann-Kendall trend tests, Continuous Wavelet Transform analysis, causal inference analysis) and qualitative (15 key stakeholder interviews) methods. The quantitative analysis employed monthly rainfall and temperature data (1991-2021) alongside RTC data (1998-2021) across 10 regions. While rainfall trends varied regionally, the wet season (April through mid-October) showed a strong link to crash severity for all regions across Ghana. Wavelet analysis showed higher crash severity in the wet season within every 2-8 months period in a particular annual year during the study period. Causal inference analysis revealed rainfall's stronger influence (3.59%) on fatal crashes during the wet season compared to temperature (0.04%). Key stakeholder interviews highlighted perceived changes in temperature and intense rainfall patterns affecting RTCs, especially during rainy seasons suggesting an association between increased rainfall and crash severity. These findings emphasize the multifaceted role of climate change on road safety and the need to address weather-specific risks.

Magnitude and outcome of road traffic accidents among patients admitted in dessie town governmental hospitals, Northeast Amhara, Ethiopia, 2022

BACKGROUND

Road traffic accidents(RTA) are a major public health problem worldwide, accounting for almost 1.24 million deaths per year and it is the number one cause of death among those aged group 15-29 years. Even though there are great benefits from access to road transportation there also poses a great challenge in the individual's daily activities ranging from minor injury to death.

OBJECTIVE

This study aimed to assess the magnitude and outcome of road traffic accidents among patients admitted in Dessie Town Governmental Hospitals, Northeast Amhara, Ethiopia, 2022.

METHODS

A five-year hospital-based retrospective descriptive cross-sectional study design was conducted among 377 road traffic accident patients admitted to Dessie Town Governmental hospitals. Data were collected by simple random methods based on patient chart reviews from June 7/, 2022 to May 23/ 2017 using a checklist adapted from the WHO standard hospital-based road traffic accident questionnaires after obtaining consent from the concerned authority. EPI-Data software version 7.2 for data entry and SPSS version 25 for statistical analysis were used. Descriptive and inferential statistics were used. Statistical significance was declared at a p-value of < 0.05 with an adjusted odds ratio (AOR) and a 95% confidence interval (CI) in the final multinomial logistic regression model.

RESULTS

The magnitude of road traffic accidents was 59%, using of logistic multi nominal logistic regression we found results such that, road traffic victims who had unstable vital signs at admission (AOR = 6.4,95% CI; 2.5-16.6), didn't get prehospital treatment (AOR = 9.3,95% CI; 4-20), and severe injury (AOR = 9, 95% CI;7-15.4), had a Glasgow coma scale of 3-5 (AOR = 5.2,95% CI; 1.4-20) were found predictors for death were as unstable vital signs at admission (AOR = 3.79,95%CI;2.1-6.8), Doesn't get prehospital treatment (AOR = 2.8, 95% CI; 1.4-5.7), Hospital stay for one to two months duration (AOR = 6,95% CI;2.3-15), and greater than two months duration (AOR = 6.5,95%CI;2.5-17) were found predictors for disability among road traffic victims.

CONCLUSIONS AND RECOMMENDATIONS

Road traffic accidents constitute a major public health problem in our setting and contribute significantly to excessively high morbidity and mortality. Unstable vital signs at admission, Client doesn't get prehospital treatment, severely injured client, and had a Glasgow coma scale of 3-5 were found predictors for death were as an unstable vital sign at admission, Client doesn't get pre-hospital treatment, Hospital stays for one to two months duration, and greater than two months duration were found predictors for disability among road traffic victims.

Identifying the key characteristics, trends, and seasonality of pedestrian traffic injury at a major trauma center in Saudi Arabia: a registry-based retrospective cohort study, 2017-2022

BACKGROUND

Pedestrian traffic injuries are a rising public health concern worldwide. In rapidly urbanizing countries like Saudi Arabia, these injuries account for a considerable proportion of trauma cases and represent a challenge for healthcare systems. The study aims to analyze the key characteristics, seasonality, and outcomes of pedestrian traffic injuries in Riyadh, Saudi Arabia.

METHODS

This study was a retrospective cohort analysis of all pedestrian traffic injuries presented to King Saud Medical City, Riyadh, and included in the Saudi Trauma Registry (STAR) database between August 1, 2017, and December 31, 2022. The analysis of metric and nominal variables was reported as mean (standard deviation, SD) or median (interquartile range, IQR) and frequencies (%), respectively. A logistic regression analysis was performed to examine the influence of patients' pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation and in-hospital mortality.

RESULTS

During the study period, 1062 pedestrian-injured patients were included in the analysis, mostly males (89.45%) with a mean (SD) age of 33.44 (17.92) years. One-third (35.88%) of the patients were Saudi nationals. Two-thirds (67.04%) of the injuries occurred from 6 p.m. until 6 a.m. Compared to other years, a smaller % of injury events (13.28%) were noticed during the COVID-19 pandemic (2020). Half (50.19%) of the patients were transported to the emergency department by the Red Crescent ambulance, and 19.68% required intubation and mechanical ventilation. Most of the patients (87.85%) were discharged home after completion of treatment, and our cohort had a 4.89% overall mortality. The logistic regression analysis showed the influence of patients' pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation (Chi2 = 161.95, p < 0.001) and in-hospital mortality (Chi2 = 63.78, p < 0.001) as a whole significant.

CONCLUSION

This study details the demographic, temporal, and clinical trends of pedestrian traffic injuries at a major Saudi trauma center. Identifying high-risk individuals and injury timing is crucial for resource allocation, targeting road safety interventions like public awareness campaigns and regulatory reforms, and improving prehospital care and patient outcomes.

Implementing Prehospital Ultrasound at the Saudi Red Crescent Authority: Perceived Barriers and Training Needs

Objective

This study examines the inherent barriers to implementing prehospital ultrasound within the Saudi Red Crescent Authority (SRCA) in Saudi Arabia.

Methods

A qualitative study was conducted to explore the perceived barriers, mode of transportation, ultrasound familiarity, and self-efficacy level of relevant stakeholders in implementing the prehospital ultrasound in SRCA. Data was collected via surveys and interviews with 24 SRCA paramedics/EMTs, 4 SRCA station administrators, and two hospital physicians to further examine the inherent barriers of implementing the prehospital ultrasound.

Results

Thematic analysis revealed the main barriers were costs of ultrasound equipment, environmental factors affecting image capture, and lack of training in ultrasound skills and interpretation. Administrators and physicians also noted concerns about machine portability and technical maintenance. Stakeholders agreed ultrasound could improve trauma diagnosis if barriers were addressed through extensive training and protocols. In prehospital care setting, the two main modes of transportation are "stay and play", involving on-scene interventions before transport, and "load and go", prioritizing rapid transport to the hospital, with the choice depending on various factors. An overwhelming 96% of paramedics/EMTs preferred a 'stay and play' approach to stabilize patients before transport, while 75% of administrators preferred 'load and go' for rapid transport to hospitals. 62.5% of paramedics were familiar with ultrasound, but only 20.8% had previously used it.

Conclusion

This study provides important insights into stakeholder perspectives on the implementation of prehospital ultrasound within the Saudi Red Crescent Authority. The findings can guide efforts to implement appropriate ultrasound use through tailored training programs and enhanced coordination across groups, aimed at improving trauma outcomes.

Clinical Characteristics and Outcomes of Limb Fractures in Saudi Children

BACKGROUND

 Children's bones are at high risk of fracture as they grow. The clinical characteristics of fractures in children differ from those in adults. Studying fractures in healthy children is critical for identifying cases of fragility fractures. The aim of this study was to assess the clinical characteristics of limb fractures as well as clinical indicators of fracture healing outcomes in healthy Saudi children seen in an emergency room.

METHODS

A retrospective review of the treatment course of all pediatric fractures and related factors treated at King Abdullah Specialist Children's Hospital (KASCH) in Riyadh between 2016 and 2018 was conducted. Children with a primary bone disorder or chronic comorbidities known to affect bone health were excluded.

RESULTS

 The study included 143 patients (mean age ± SD = 8.23 + 3.76 years), and 71% (n = 102) were males. Motor vehicle accidents (MVAs) were the most common mechanism of injury, accounting for 50 (35%) cases, followed by fall injuries, sports injuries, and pedestrian accidents at 45 (31.4%), 16 (11.2%), and 13 (9.1%), respectively. A total of 178 fractures were reported, with the femur (n = 75, 42.1%) being the most common of the reported fracture sites, followed by the forearm (n = 44, 24.7%). The most common type of fracture was transverse fracture (n = 96, 54% of patients). Vitamin D levels were measured in 53/143 cases. Of these, vitamin D deficiency was found in 38 (71.7%) patients. The average time for fracture healing was 32.9 ± 30.2 weeks. The mechanisms of injury, including MVAs and sports injuries, as well as femur and forearm fractures, were clinical factors that were independently associated with a longer duration of fracture healing time (p < 0.001), but age, gender, and vitamin D status were not associated with that outcome.

CONCLUSION

 MVAs and fall injuries were the most common causes of fracture in our patients. MVAs and sports injuries were associated with prolonged healing time. Large prospective, multicenter, or field studies may be required to further explore clinical characteristics, outcomes, and environmental factors.

Prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia: A cross-sectional study

BACKGROUND

Professional drivers in Saudi Arabia may be at increased risk for mental illness because of their expatriate status, long driving hours, and unhealthy lifestyles.

OBJECTIVE

To assess the prevalence and correlates of depressive symptoms among professional drivers in Saudi Arabia, most of whom are expatriates.

METHODS

Professional drivers (n = 324) were interviewed after convenient sampling of transportation companies. The Depression Anxiety Stress Scale-21 (DASS-21) was used to screen for depressive symptoms. Correlates of depressive symptoms were identified using Cox regression with a fixed follow-up time.

RESULTS

Of the drivers, 20.4% had moderate to severe depressive symptoms. Sleep quality was found to be a significant independent correlate of depressive symptoms. Drivers with poor and fair sleep quality had higher risk of depressive symptoms than drivers with excellent sleep quality (poor: OR = 5.8, CI: 1.95-17.11; fair: OR = 4.5, CI: 1.68-11.96).

CONCLUSION

The frequency of depressive symptoms among professional drivers in Saudi Arabia is high (one out of five). Companies should consider screening for depressive symptoms and sleep disorders among employees and should provide referrals as needed.

[Combined use of biomaterials and revascularisation in autoplasty of ulnar nerve]

Surgical treatment of peripheral nerve injuries is effective in only 50% of cases. This is primarily due to the significant extent of the diastasis between the fragments of the damaged nerve, in which autoplasty has to be performed. The drawbacks of this technique are the formation of scar tissue, possible necrotisation of the autograft, mismatch of the donor and recipient nerve diameters. In order to overcome these drawbacks and improve the efficiency of surgical intervention, the study presents a clinical case of successful multifascicular ulnar nerve autoplasty with the use of domestic biodegradable biomaterials SpheroGel and ElastoPob, revascularization of the autograft with a connective tissue flap on a vascular pedicle. A persistent regression of local pain syndrome was observed in the early postoperative period. The effectiveness of the performed surgical intervention was confirmed by ultrasound examination: there was no evidence of neuroma in the area of the operation, regeneration of nerve bundles was noted at the site of stitching. Positive dynamics was observed in the results of VAS, DN4, DASH questionnaires.

Prevalence and Determinants of Road Traffic Accidents in Saudi Arabia: A Systematic Review

Globally, the frequency of road traffic accidents (RTAs) is sharply rising. It is concerning that the number of RTAs in the Kingdom of Saudi Arabia (KSA) has risen within the past ten years. As a result, laws governing things like speeding and seat belt use must be implemented to ensure driving safety. This study aims to determine the prevalence and determinants of road traffic accidents in Saudi Arabia. A thorough search was carried out in November 2023, mostly using PubMed, in compliance with PRISMA criteria. The search was limited to English-language research examining the causes of road traffic accidents and their prevalence. Certain inclusion and exclusion criteria were developed to guarantee the quality and applicability of the evaluated research. A wide spectrum of research from Saudi Arabia was included in the study without focusing on a specific gender. A discernible pattern indicated a high proportion of individuals affected by road traffic accidents. According to the findings of our investigation, there is growing evidence that Despite recent improvements in the incidence of road accidents, there is still significant variation in the incidence of accidents in Saudi Arabia. These results indicate that further study is needed to understand road accident prevention better.

Analysis of road traffic injuries presented to the emergency department in the Eastern Province of Saudi Arabia: a hospital-based study

The increasing incidence of road traffic injuries (RTIs) has contributed to the disability and death of millions of people on both a national and global level. This retrospective study was conducted at King Fahad University Hospital (KFUH), Khobar, Saudi Arabia, and included all patients who presented at the emergency department due to road traffic accidents (RTAs) between January 1st, 2022, and December 31st, 2022. Patient data was retrieved from the health information system at KFUH. Descriptive and inferential analysis were performed with several variables analyzed using multivariate logistic regression and factorial ANOVA (MANOVA). During this period, 921 patients were treated at the hospital's emergency department. Of these, 611 (66.3%) were men and 310 (33.7%) were women. The most frequently affected age group was 16-25, representing 427 (46.4%) cases. Most patients were Saudi citizens (837, 90.9%). Among the patients, 19 (2.1%) required surgical treatment within 24 hours of the RTA, and 29 (3.1%) were admitted to the surgical intensive care unit (SICU). There were eight fatalities, representing 0.9% of the cases. January had the highest number of RTAs (12.7%). Moreover, 463 individuals (50.3%) had some form of injury, the most common type being lacerations and abrasions (n=228, 24.8%). Upper limb fractures were the most frequent type of fracture, occurring in 73 cases (7.9%). Being male (P=0.001), non-Saudi (P=0.014), and experiencing accidents during June and July (P=0.002) were associated with an increased prevalence of injury. Mortality had a statistically significant relationship with different patient age groups (P=0.014), patient citizenship (P=0.005), and length of hospital stay (P<0.001).

The effect of social media campaign on parental knowledge, attitudes and practices regarding the use of children car seats in the Gulf region

BACKGROUND

Motor vehicle crashes (MVCs) are the leading cause of child deaths in the Gulf Cooperation Council. This study aimed to investigate the effect of a social media educational campaign on parents' knowledge of child safety seats.

METHODS

We conducted a pre-post interventional study as an online educational module in Arabic and English. The module link was shared on social media and was accompanied by a pre-post survey that included questions about demographics, knowledge, and practices of car seat use.

RESULTS

A total of 303 participants completed the campaign, with 23.8% fathers and 76.2% mothers answered the survey. The majority of participants were from Saudi Arabia (95.7%), while 4.3% were from other Gulf Cooperation Council (GCC) countries. Most parents agreed on the importance of organizing awareness campaigns and having a law to enforce the use of car seats. The pre-survey mean knowledge score was 11.64, which significantly increased to 13.1 in the post-survey (p < 0.001).

CONCLUSIONS

The intervention of the educational campaign through social media resulted in a significant increase in parents' knowledge and awareness of the importance of using car seats correctly. This study highlights the potential effectiveness of social media campaigns in improving parents' knowledge and awareness of child safety seats.

Investigating the effect of road condition and vacation on crash severity using machine learning algorithms

Investigating the contributing factors to traffic crash severity is a demanding topic in research focusing on traffic safety and policies. This research investigates the impact of 16 roadway condition features and vacations (along with the spatial and temporal factors and road geometry) on crash severity for major intra-city roads in Saudi Arabia. We used a crash dataset that covers four years (Oct. 2016 - Feb. 2021) with more than 59,000 crashes. Machine learning algorithms were utilized to predict the crash severity outcome (non-fatal/fatal) for three types of roads: single, multilane, and freeway. Furthermore, features that have a strong impact on crash severity were examined. Results show that only 4 out of 16 road condition variables were found to be contributing to crash severity, namely: paints, cat eyes, fence side, and metal cable. Additionally, vacation was found to be a contributing factor to crash severity, meaning crashes that occur on vacation are more severe than non-vacation days.

The Epidemiology of Prehospital Ambulance Crashes: A National Experience Across Saudi Red Crescent Authority

Introduction Road traffic injuries (RTIs) have a significant impact on the healthcare system as well as the global economy. RTIs involving ambulance crashes not only cause delays in patient transfers but also endanger ambulance occupants and other road users. Due to the rising numbers of RTIs in the Kingdom of Saudi Arabia (KSA), the country's primary provider of prehospital services the Saudi Red Crescent Authority (SRCA) has established a new Trauma Epidemiology Center (TEC) following the KSA 2030 vision. Objective This current study was conducted to determine the causes and management-related aspects of RTIs involving ambulance crashes in KSA. We aim to highlight the current status and guide further efforts to fill gaps in knowledge and on-ground changes to prevent ambulance crashes, enhance patient care, and reduce morbidity and mortality. Method This is a descriptive, retrospective cross-sectional observational study of ambulance crashes in Saudi Arabia between January 2020 and July 2022. The data was extracted from the SRCA electronic database platform. Results One hundred and sixty accidents were recorded between 2020 and 2022 with the highest proportion of accidents recorded in Riyadh 44.29%; followed by the Eastern Province and Makkah, 15% and 12%, respectively. Ninety percent of ambulance crashes were due to direct collisions and caused by other parties in 58% of cases. It is worth mentioning that ambulance drivers fastened their seat belts in 99% of crashes. Conclusion This study highlights the epidemiology and distribution of prehospital ambulance crashes in the KSA. Most crashes occurred in urban areas with a reasonable contribution of the public in such crashes. Understanding contributing factors related to the vector, driver behaviors, and the surrounding environment is crucial to guide national preventive measures and help decision-makers to implement proper corrective actions.

A Decade's Perspective on the Orthopedic Workforce in Saudi Arabia

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons' demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

Emergency Medical Service Response Time for Road Traffic Accidents in the Kingdom of Saudi Arabia: Analysis of National Data (2016-2020)

Despite preventive measures and initiatives, road traffic accidents are on the rise in the Kingdom of Saudi Arabia. This study aimed to investigate the emergency medical service unit's response to RTA by socio-demographic and accident-related variables in the Kingdom of Saudi Arabia. This retrospective survey included Saudi Red Crescent Authority data on road traffic accidents between 2016 and 2020. As part of the study, information on sociodemographic characteristics (e.g., age, sex, and nationality), accident-related data (type and place of the accident), and response time to road traffic accidents were extracted. Our study included 95,372 cases of road traffic accidents recorded by the Saudi Red Crescent Authority in the Kingdom of Saudi Arabia between 2016 and 2020. Descriptive analyses were performed to explore the emergency medical service unit's response time to road traffic accidents, and linear regression analyses were performed to investigate the predictors of response time. Most of the road traffic accident cases were among males (59.1%), and the age group of 25-34 years accounted for about a quarter (24.3%), while the mean age of the road traffic accident cases was 30.13 (±12.86) years. Among the regions, the capital city of Riyadh experienced the highest proportion of road traffic accidents (25.3%). In most road traffic accidents, the mission acceptance time was excellent (0-60 s; 93.7%), movement duration was excellent (<120 s; 91.1%), reaching site duration was excellent (<12 min; 57.9%), treatment start time was excellent (<120 s; 76.4%), duration at the scene was poor (>15 min; 40.8%), reaching hospital duration was good (30-60 min; 52.7%), and in-hospital duration was poor (>15 min; 44.1%). Regions, places and types of accidents, age, gender, and nationality of victims were significantly associated with different parameters of response time. Excellent response time was observed in most of the parameters except the duration at the scene, reaching hospital duration, and in-hospital duration. Apart from the initiatives to prevent road traffic accidents, policymakers should focus on strategies to improve accident response time to save lives.

Methods to evaluate driving competence for people with acquired brain injury (ABI): A systematic review

Driving is essential for independence, community involvement and quality of life. Driving is the primary transportation method in Saudi Arabia. Despite the high rates of brain injuries and disability in Saudi Arabia, currently there are no guidelines regarding driver assessment and rehabilitation to facilitate people with brain injuries to resume driving. Therefore, this systematic review aimed to understand the assessment methods used internationally to evaluate driving competence for people with acquired brain injuries (ABI). A systematic search of six electronic databases was conducted by two authors and twenty-six studies were identified for review. Four main approaches to driver assessment: clinical assessments such as neuropsychological tests, off-road screening tools, simulator testing, and comprehensive driving assessment were identified. However, our findings revealed a lack of consistency in their use to assess driving competence after ABI. On-road driving performance tests were predominantly used to determine driving competence either independently or in combination with another method in over two-thirds of the reviewed studies. While clinical assessments of cognitive impairments showed some capacity to predict driving performance of people with ABI, they should be used with caution since they cannot replace on-road driving performance tests. Driver assessment should be part of rehabilitation following high prevalence conditions such as ABI. This systematic review offers guidance for Saudi clinicians, as well as policymakers, about providing rehabilitation services for people with ABI, and recommendations for further research and collaborations to improve this much-needed area of practice.

Factors Contributing to Traffic Accidents in Hospitalized Patients in Terms of Severity and Functionality

Trauma-related injuries in traffic-accident victims can be quite serious. Evaluating the factors contributing to traffic accidents is critical for the effective design of programs aimed at reducing traffic accidents. Therefore, this study identified which factors related to traffic accidents are associated with injury severity in hospitalized victims. Factors related to traffic accidents, injury severity, disability and data collected from blood toxicology were evaluated, along with associated severity and disability indices with data collected from toxicology on victims of traffic accidents at the largest tertiary hospital in Latin America. One hundred and twenty-eight victims of traffic accidents were included, of whom the majority were young adult men, motorcyclists, and pedestrians. The most frequent injuries were traumatic brain injury and lower-limb fractures. Alcohol use, hit-and-run victims, and longer hospital stays were shown to lead to greater injury severity. Women, elderly individuals, and pedestrians tend to suffer greater disability post-injury. Therefore, traffic accidents occur more frequently among young male adults, motorcyclists, and those who are hit by a vehicle, with trauma to the head and lower limbs being the most common injury. Injury severity is greater in pedestrians, elderly individuals and inebriated individuals. Disability was higher in older individuals, in women, and in pedestrians.

Deaths, causes, and their frequency among Saudi citizens: A descriptive analysis of data from the 2017 Population Characteristics Survey

BACKGROUND

The number of deaths, causes, and frequency measures are crucial in determining the health of a country's population.

OBJECTIVE

The current study aimed to estimate deaths, causes of death, and their frequency for Saudi nationals in 2017.

METHODS

In this descriptive study, we used data from the 2017 Population Characteristics Survey (n = 14,215,901) and performed secondary data analysis between November 2021 and February 2022. We used a total number of survey samples to compute the deaths. The cause of death was determined by dividing the total number of fatalities according to sex. We calculated the overall population-, administrative region-, and gender-wise percentages, rates per 1,000 people per year, the ratios for mortality, and their reasons.

RESULTS

There were 58,915 (0.4%) total deaths, including 0.3% and 0.2% deaths among females and males, respectively. The illness was the most frequent cause of mortality (46.5% or 465 per 1,000 population/year), notably in women (52.5% or 525 per 1,000 population/year). The fatality rate was higher due to traffic accidents (a total of five in every female and four males in every female).

CONCLUSION

In 2017, illness-especially in women-was the cause of death. Road car accidents had a high mortality rate, especially among males. Saudi Arabia has lower death rates than other Arab nations and high-, moderate-, and low-income nations.

Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia

Background

Maxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center.

Methods

A retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period.

Results

Among the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females.

Conclusion

Our study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.

Blunt Traumatic Tracheobronchial Injury: a Clinical Pathway

Background

Motor vehicle collisions (MVC) are a major burden on healthcare systems. Saudi Arabia is one of the countries with a high mortality rate of MVC. Blunt tracheobronchial injuries are rare; however, it is a catastrophic event that requires a high center of care. Lack of experience and advanced faculty prompt early stabilization and transfer of the victim for advanced care. Due to the uncertainty of management of these injuries, we would like to share our experience in dealing with such injuries.

Objective

To address the difficulties in initial management and transfer of patient with blunt traumatic tracheobronchial injuries.

Methods

This is a single-center retrospective case-series study including patients admitted as cases of trauma including all age groups with blunt acute tracheobronchial injuries confirmed by imaging or bronchoscope.

Results

In our study, four patients with tracheobronchial injuries were identified, and a retrospective analysis was performed. Two of the males and one of the females are adults, while the other two are pediatrics. Two of them have a right main bronchial injury and the other two have a left main bronchial injury. Posterolateral thoracotomy and bronchial anastomosis were performed on all four patients and were followed up.

Conclusion

In Saudi Arabia, blunt trauma is a prevalent type of injury, although tracheobronchial injuries are uncommon. In the event of trauma, a high index of suspicion of tracheobronchial injuries in a high mechanism injury warrants prompt treatment. Due to a lack of experienced and specialized hands in this field, management may be delayed, and eventually lead to unfavorable outcomes, hence we thought of a guide to facilitate the decision-making.

Generation Paths of Major Road Accidents Based on Fuzzy-Set Qualitative Comparative Analysis

In the process of continuously promoting safety management, major road accidents have become a key obstacle to improving overall road safety. The analysis of the overall road accidents hides the characteristics and laws of major road accidents. To clarify the causes of major road accidents, an analysis framework of "individual-vehicle-environment-management" is presented based on a literature review. Considering the interaction of the above variables, the fuzz-set qualitative comparative analysis (fsQCA) was used to explore the generating paths of major road accidents based on 42 road accidents. The work shows that: (1) Major road accidents are caused due to the interactive coupling of "individual-vehicle-environment-management" elements. Major road accidents can occur with normal driving behaviors or sufficient response and rescue capabilities. (2) General road accidents and relatively major road accidents are more likely to occur in the presence of driving behavior errors, favorable road facilities, and sufficient response and rescue capabilities. Moreover, major road accidents are more likely to occur due to large vehicles with adverse vehicle performances. (3) There are three path modes and five condition configurations in major road accidents, namely individual-vehicle-management induced, individual-vehicle-environment induced, and vehicle induced mode. This work enriches the accident causation mode from a new configuration perspective and explains which variable combinations lead to the occurrence of major road accidents. Clarification of the differences between general accidents and major accidents will help to accurately predict and restrain the development of major road accidents.

INVESTIGATION OF RADIATION RISKS BASED ON THE CLINICAL FINDINGS FROM HEAD CT SCANS IN TRAUMA

This study aimed to investigate the radiation risks in terms of effective dose and the cancer risk probability resulting from computed tomography (CT) scans of the head for traumatic patients and determine how often traumatic abnormalities occur. Data were collected retrospectively for 138 traumatic patients from the picture archiving and communication system, including exposure parameters and clinical findings. The mean values of the dose length product, CT dose index volume and effective dose for the CT head examinations were 787 ± 67.7 mGy•cm, 40.1 ± 1.33 mGy and 1.47 ± 0.12 mSv, respectively. Of the total cases of CT scans of the head, 57.2% (n = 79) exhibited positive findings. The cancer risk probability for the patients was 6.04 × 10-5 per procedure, with no statistically significant differences between positive and negative findings (p = 0.345). Taking into consideration the justification of the examination, the risk of missing positive findings and the radiation risks, the immediate benefit of head CT for trauma patients for guiding medical decisions outweighs the radiation risk that will probably manifest later.

Bone Fracture Patterns and Distributions according to Trauma Energy

Background

This study investigates the effect of injury mechanism and energy on fracture patterns and distributions. Also, it compares differences in bone fracture patterns based on injury mechanism, gender, and age.

Methods

Three thousand and sixty-six admitted patients with bone fractures were reviewed retrospectively, and the fractures were analyzed regarding age, gender, and mechanism of injury. Fractures were located in eleven bones. However, the forearm, hand, leg, and foot were considered one bone, and the fracture was then subclassified according to the anatomic position within each bone. Trauma energy was classified according to the mechanism of injury where simple falls were considered low-energy injury while falling from a height, road traffic accidents, bullet, and industrial injuries were considered high energy.

Results

Males represented most of the patients, and most injuries occurred in adults. However, the male patients were more prone to injuries than females across all age groups below fifty years, women above fifty years were more frequent, and a third of females' injuries occurred in the elderly. Simple falls represent two-thirds of the trauma mechanism, and falling from a height and road traffic accidents are the most common high-energy injuries and more prevalent in males. Scapular, clavicular, distal humerus, and shaft of long bones fractures were more prevalent in males. In contrast, females had a higher frequency of proximal humerus, proximal and distal femur, distal leg, and thoracic spine fractures. Industrial injuries are more frequent in males; thus, hand injuries are more frequent. Pathological fractures were higher in females, and spine and pelvic fractures were more associated with high-energy injuries.

Conclusions

The trauma's energy determines the bone injury's extent and nature. Knowing the trauma mechanism is essential to expect the extent of injuries and construct preventive measures accordingly.

Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends

Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: "Pedestrian crash frequency models", "Pedestrian injury severity crash models", "Traffic engineering measures in pedestrians' safety", "Global reports around pedestrian accident epidemiology", "Effect of age and gender on pedestrians' behavior", "Distraction of pedestrians", and "Pedestrian crowd dynamics and evacuation". Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely "Collision avoidance and intelligent transportation systems (ITS)", "Epidemiological studies of pedestrian injury and prevention", "Pedestrian road crossing and behavioral factors", "Pedestrian flow simulation", and "Walkable environment and pedestrian safety". Finally, "autonomous vehicle", "pedestrian detection", and "collision avoidance" themes were identified as having the greatest centrality and development degrees in recent years.

Risky Roads in Kuwait: An Uneven Toll on Migrant Workers

This descriptive study reveals trends in citations and traffic-related mortality in Kuwait. Secondary data were utilized, where data on road traffic citations were obtained from the traffic police in the Ministry of Interior for the years from 2011 to 2015, and road traffic mortality data for the study period were obtained from the Ministry of Health.

OBJECTIVE

To describe recent trends in data related to road traffic safety in Kuwait over time, which could serve as an important indicator for the level of enforcement of existing traffic regulations. Descriptive summary statistics are presented.

RESULTS

There was a total of 24.2 million traffic violations during the study period. The number rose dramatically from 4 million citations in 2011 to nearly 6.5 million in 2015. The indirect method of citation (issued indirectly via surveillance methods) constituted a higher percentage of citations, 70.4%, compared to the direct method of citation (issued directly by the police officer), 29.6%. Furthermore, the top reason for citation was speeding, followed by parking in no parking/handicapped zones, driving with an expired license, and crossing a red light. Road traffic fatalities (RTFs) in Kuwait from 2011 to 2015 totaled 2282. About 450 people die each year in Kuwait from road traffic injuries and a slightly decreasing trend was found. Non-Kuwaitis have RTF counts that are four times higher than Kuwaitis, with 1663 and 263 deaths, respectively.

CONCLUSIONS

Road traffic safety continues to be a major problem in Kuwait. Increases in citation issuance show a rise in traffic regulation enforcement, yet risky driving behaviors continue to account for most violations issued. Harsher penalties, road safety education, and implementing graduated driving licensing may be warranted to increase the safety of the roads.

Involvement of Road Users from the Productive Age Group in Traffic Crashes in Saudi Arabia: An Investigative Study Using Statistical and Machine Learning Techniques

Road traffic crashes (RTCs) are a major problem for authorities and governments worldwide. They incur losses of property, human lives, and productivity. The involvement of teenage drivers and road users is alarmingly prevalent in RTCs since traffic injuries unduly impact the working-age group (15–44 years). Therefore, research on young people’s engagement in RTCs is vital due to its relevance and widespread frequency. Thus, this study focused on evaluating the factors that influence the frequency and severity of RTCs involving adolescent road users aged 15 to 44 in fatal and significant injury RTCs in Al-Ahsa, Saudi Arabia. In this study, firstly, descriptive analyses were performed to justify the target age group analysis. Then, prediction models employing logistic regression and CART were created to study the RTC characteristics impacting the target age group participation in RTCs. The most commonly observed types of crashes are vehicle collisions, followed by multiple-vehicle and pedestrian crashes. Despite its low frequency, the study area has a high severity index for RTCs, where 73% of severe RTCs include individuals aged 15 to 44. Crash events with a large number of injured victims and fatalities are more likely to involve people in the target age range, according to logistic regression and CART models. The CART model also suggests that vehicle overturn RTCs involving victims in the target age range are more likely to occur as a result of driver distraction, speeding, not giving way, or rapid turning. As compared with the logistic regression model, the CART model was more convenient and accurate for understanding the trends and predicting the involvement probability of the target age group in RTCs; however, this model requires a higher processing time for its development.

Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Head Injury: a Single-Center Retrospective Study

Aim

To determine the pattern and in-hospital mortality of thoracoabdominal injuries associated with head injuries (HI) due to motor vehicle accidents. Settings and Design. A single-center retrospective study in a tertiary care hospital, level 1 trauma center in the southern region of Saudi Arabia.

Methods and Materials

Descriptive analysis was conducted to evaluate sex, age, types of head injury, associated thoracoabdominal injuries, particular admission day, duration of hospital stay, and discharge category, and associations between different variables and outcomes were analyzed.

Results

The cohort had a mean age of 26.9 ± 15.8 years, with a predominance of men (86.9%). Thoracoabdominal injuries were present in 6.8% of MVA-related HI, and 14.3% of victims expired during their hospital stay, mostly within the first 10 days. All expired patients had posttraumatic brain lesions. Moreover, there was a significant association between intensive care unit (ICU) admission and poor prognosis.

Conclusions

Existence of posttraumatic brain lesions and requirement of ICU admission are significant variables affecting outcomes in patients with motor vehicle-associated HI with concomitant thoracoabdominal trauma in this study. Patients who survived the first 10 days after trauma seemed to have a better prognosis. More efforts are needed to reduce the health burden of this lethal injury.

Test-retest reliability of the Arabic translation of the Lower Extremity Functional Status of the Orthotics and Prosthetics Users' Survey

BACKGROUND

The number of amputations secondary to diverse factors in Arabic countries is expected to rise in the coming years. Therefore, there is a need for high-quality service that can be monitored by the use of standardized patient-reported outcome measures of amputee patients' functional status. This study aimed to translate the Lower Extremity Functional status Orthotics and Prosthetics Users' Survey (OPUS-LEFS) to Arabic and test its reliability in a sample of Arabic-speaking people with amputation.

METHODS

Standard forward and backward translation, followed by an examination by a team of experts, and then preliminary testing were conducted on the final translation. The OPUS-LEFS was cross-culturally validated, and its test-retest reliability was examined in patients with lower extremity amputations (N = 67).

RESULTS

No issues were observed concerning the patients' understanding or the meaning of the items on the Arabic translation of the OPUS-LEFS. The intraclass correlation coefficient was 0.99 (95% confidence interval [CI]: 0.985 to 0.995), and the mean difference was -0.278 (95% CI: -5.83 to 5.28), indicating excellent test-retest reliability.

CONCLUSIONS

The study's results suggest that the Arabic translation of the OPUS-LEFS is a reliable tool that can be recommended for future use as an outcome measure for patients from Arabic-speaking nations with little knowledge of the English language.

Levels and Relationships of Impulsivity and Aggressive Driving in Shaqra, Saudi Arabia

Background: Aggressive driving is prevalent and may be associated with impulsivity. The relationships between these variables among Saudi drivers have received scant attention. In this study, we aimed to examine the level of aggressive driving and its relationships with impulsivity among Saudi drivers in Shaqra. Methods: Overall, 504 Saudi drivers were recruited and assessed in this cross-sectional study using demographic and driving proforma, a self-reporting Barratt impulsiveness scale (BIS), and an Aggressive Driving Behavior Scale (ADBS). Results: BIS and ADBS had mean scores of 37.97 (3.24) and 21.74 (8.51), respectively. In linear regression analysis, the value of the BIS non-planning subscale negatively predicted the value of the ADBS Conflict subscale (beta = -.151, p = .002) and Speeding subscale (beta = -.103, p = .031). In contrast, the value on the score of the BIS Motor subscale statistically significantly and positively predicted the value on the score of the ADBS Speeding subscale (Beta = -.103, p = .032). Conclusion: The result shows a differential link between the component of impulsivity and aggressive driving. The lack of foresight is negatively linked with conflict behavior and high- speed driving, whereas acting without thinking is positively associated with high-speed driving.

Awareness level of safe driving knowledge and practice of specific population drivers: behavioral assessment and educational intervention

PURPOSE

This study aimed to assess car-driving behaviors and attitudes and to measure the changes in the knowledge and behavioral practices associated with road safety measures of 1333 randomly selected young-adult participants (aged 18-24 years) from Jazan University in Gizan city, Saudi Arabia.

METHODS

Data were collected using cross-sectional survey and quasi experimental pre- and post-evaluation educational intervention study including structured questionnaire and take-home educational material.

RESULTS

Results revealed that low compliance with the safety index significantly increased the risk of traffic injuries by 20% [OR = 0.80, 95% CI = (0.59-1.01)]. Whereas the medium category of the safety compliance index is significantly associated with an increasing number of injuries by 6% [OR = 0.94, 95% CI = (0.61-1.52)]. In contrast, both high and medium categories of risk behavior index increased the risk of traffic injuries [OR = 1.08, 95% CI = (0.82-1.43); OR = 0.80, 95% CI = (0.57-1.10), respectively]. Some improvement in risky behavioral practices was seen after the intervention including 'not playing loud music' [86.3%, (P = 0.05)], 'not using mobile phones' [89.4%, (P < 0.05)], and 'not using unprofessional checkups of the car' [71.5%, (P < 0.05)].

CONCLUSION

Ultimately, this unpleasant situation may recommend avoidance of these kinds of intermittent awareness programs; instead, embedding a continuous road safety learning within the life-long educational system as a better and more realistic intervention for reducing the number of road accidents and injuries. Further, establishing various modes of high-capacity city-link public transportation remains among the most recommended strategic and effective options that can curb road traffic injuries in the long run.

The prevalence of long-term rehabilitation following motor-vehicle crashes in Saudi Arabia: a multicenter study

Introduction

In Saudi Arabia, motor-vehicle crashes (MVC) are the leading cause of disability-adjusted life years (DALYs). There is limited information locally on the magnitude and need for rehabilitation following MVC. This study examined the prevalence of MVC patients requiring long-term rehabilitation and the epidemiology of associated injuries.

Methods

A retrospective study was conducted at four hospitals of the National Guard Hospitals Affairs from January 2016 to March 2019. The study used data from an institutional trauma registry of all MVC admissions. Chi-square tests, bivariate and multivariate analyses were conducted to compare patients requiring long-term and short-term rehabilitation.

Results

The study included 506 patients. The study population was relatively young, with an average age was 32.8 ± 15.5 years, and the majority were males. Over two-thirds (71.3%) of patients required long-term rehabilitation. Half the patients sustained multiple fractures, and 17.0% sustained traumatic brain injuries. Overall, 53.1 and 61.8% of patients required occupational and physiotherapy, respectively. Those admitted to the intensive care unit were four times more likely to need long-term rehabilitation.

Conclusions

We found a significant burden of long-term rehabilitation following MVC. Patients were relatively young, thus posing a significant burden on future healthcare utilization. Policymakers should use these findings to guide primary, secondary, and tertiary prevention to improve health outcomes.

Real-Time Security Health and Privacy Monitoring for Saudi Highways Using Cutting-Edge Technologies

Kingdom of Saudi Arabia (KSA) highways hold the record for having the straightest, longest highways in the world. Since the country’s major population centers are dispersed across the country and due to the country’s geography, which includes valleys, deserts, and mountains, among other landscapes, these highways connect the many cities of the kingdom and neighboring nations. However, it is still challenging to provide emergency assistance in a timely way in the case of accidents, such as first aid, medical aid, police protection, etc. The transport ministry is actively working on improvements and safety features for the drivers. This research proposes a CET (cutting-edge technologies)-based model named the real-time security, health, and privacy monitoring model for passenger safety (RTSHPMP) for securing the traveler’s safety and privacy besides medical and legal help. The vehicle will be equipped with IoT-based front-back cameras to collect real-time data and share it with the cloud using 5G network. The local and national trusted authorities (TAs) will monitor the collected cloud data and inform the government machinery (police, first aid, fire brigade, hospitals) in the case of an accident. In addition, the data collected through other vehicles on the road at the time of the incident will help supply evidence linked to the accident. The RTSHPMP was evaluated with the help of a case study, and the results show that it provides an efficient and secure mechanism for traveler safety on Saudi highways at the time of need.

Practice in child restraint system use among attendees of Well-baby clinics in Jeddah, Saudi Arabia

Background:

The systematic use of child restraint system (CRS) while driving has been promoted by the WHO to improve road safety.

Objectives:

To assess the levels of practice in CRS use for children aged ≤5 years among mothers attending the Well-baby clinics and to explore the associated factors and attitudes.

Methods and Material:

A cross-sectional study was conducted among mothers visiting the Well-baby clinics at five primary health care centers in Jeddah, Saudi Arabia, using a multistage stratified-cluster sampling. Practice in CRS was assessed by interviewing the participants regarding the availability of a CRS in their car, usage frequency for a child <5 years, and alternative child-sitting methods. Sociodemographic data, further road safety parameters, and attitudes were analyzed as independent factors of adequate practice using multivariate logistic regression.

Results:

Of the 192 included mothers, eight (4.2%) had a history of accident while driving with a child. Majority of the participants (62.5%) declared not having their cars equipped with a CRS and used inappropriate car-sitting methods. Of the 37.5% who had CRS in their cars, 27.1% declared using it always or frequently. Adequate practice in CRS was independently associated with mother’s age (OR = 0.91, P = 0.09), low (OR = 0.10, P = 0.001) and moderate family income (OR = 0.23, P = 0.012), and the belief that CRS is not essential while driving with children (0.32, P = 0.023).

Conclusions:

There is inadequate practice in child road safety among families attending the Well-baby clinics in Western Saudi Arabia, which is associated with several misconceptions and negative attitudes towards the utility of CRS.

Cost of healthcare rehabilitation services following road traffic injuries: Results from a Level-I trauma center in Saudi Arabia

BACKGROUND

Road traffic injuries (RTIs) are the second leading cause of mortality in Saudi Arabia. The high rate of RTIs puts a strain on rehabilitation services. Yet, little is known of the economic burden of nonfatal RTIs and rehabilitation services. This study, therefore, aims to describe the annual rehabilitation costs associated with RTIs at a local trauma center.

MATERIALS AND METHODS

This study was conducted among all the 17 years or older patients hospitalized at King Abdulaziz Medical City in Riyadh following RTIs and required rehabilitation care. We included 299 patients who met the inclusion criteria and were followed for one year after discharge from the index hospital. The data was abstracted through retrospective review of patients' medical records. All rehabilitative services utilized by the healthcare system were recorded. To describe the economic burden, the mean, median, standard deviation, and interquartile range (IQR) were calculated. Total costs were aggregated for all patients to estimate overall costs.

RESULTS

The study population was relatively young (31 years ± 14.4). The total annual rehabilitation cost of patients was Saudi Riyals (SAR) 6,113,781 (IQR: 20,589.3 - 3,125 = 17,464.3), and the average for each patient was SAR 20,447 (median = 7875). Patients aged 40-59 years and ≥60 years accounted for the highest average rehabilitation cost of SAR 31,563.99 and 32,639.21, respectively. Rehabilitation visits incurred the highest cost (mean SAR 1,494,124), followed by bed utilization which cost SAR 1,311,972 and radiology examination at SAR 1,032,261. The cost of motorcycle injuries was relatively higher (SAR 44,441.0) than other injury mechanisms.

CONCLUSION

This study underlines the economic burden of rehabilitation services resulting from RTIs. Public health interventions are needed to reduce the burden of RTIs by dealing with their preventable causes and improving road safety measures. These findings may be useful to policymakers and researchers to support and improve rehabilitation services in Saudi Arabia.

Development of the Saudi Arabian trauma system

A dedicated network-based trauma system ensures optimal care to injured patients. Considering the significant burden of trauma, the Kingdom of Saudi Arabia is striving to develop a nationwide trauma system. This article describes the recent design, development, and implementation of the Saudi Arabian trauma system in line with Vision 2030. The basis of our strategy was the find, organize, clarify, understand, select-plan, do, check, and act (FOCUS-PDCA) model, developed by engaging key stakeholders, including patients. More than 300 healthcare professionals and patients from around the Riyadh region assessed the current system with three solutions and roadmap workshops. Subsequently, the national clinical advisory group (CAG) for trauma was formed to develop the Saudi Arabian trauma system, and CAG members analyzed and collated internationally recognized trauma systems and guidelines. The guidelines' applicability in the kingdom was discussed and reviewed, and an interactive document was developed to support socialization and implementation. The CAG team members agreed on the guiding principles for the trauma pathway, identified the challenges, and finalized the new system design. They also developed a trauma care standard document to support and guide the rollout of new trauma networks across the kingdom. The CAG members and other stakeholders are at the forefront of implementing the trauma system across the Riyadh region. Recent trauma system development in Saudi Arabia is the first step in improving national trauma care and may guide development in other locations, regionally and internationally, to improve outcomes.

Outcomes of Trauma Patients Present to the Emergency Department with a Shock Index of ≥1.0

Introduction

The study aimed primarily to evaluate the association between the initial shock index (SI) ≥1.0 with blood transfusion requirement in the emergency department (ED) after acute trauma. The study's secondary aim was to look at the outcomes regarding patients' disposition from ED, intensive care unit (ICU) and hospital length of stay, and deaths.

Methods

It was a retrospective, cross-sectional study and utilized secondary data from the Saudi Trauma Registry (STAR) between September 2017 and August 2020. We extracted the data related to patient demographics, mechanism of injuries, the intent of injuries, mode of arrival at the hospital, characteristics on presentation to ED, length of stay, and deaths from the database and compared between two groups of SI <1.0 and SI ≥1.0. A P < 0.05 was statistically considered significant.

Results

Of 6667 patients in STAR, 908 (13.6%) had SI ≥1.0. With SI ≥1.0, there was a significantly higher incidence of blood transfusion in ED compared to SI <1.0 (8.9% vs. 2.4%, P < 0.001). Furthermore, SI ≥ 1.0 was associated with significant ICU admission (26.4% vs. 12.3%, P < 0.001), emergency surgical intervention (8.5% vs. 2.8%, P < 0.001), longer ICU stay (5.0 ± 0.36 vs. 2.2 ± 0.11days, P < 0.001), longer hospital stays (14.8 ± 0.61 vs. 13.3 ± 0.24 days, P < 0.001), and higher deaths (8.4% vs. 2.8%, P < 0.001) compared to the patient with SI <1.0.

Conclusions

In our cohort, a SI ≥ 1.0 on the presentation at the ED carried significantly worse outcomes. This simple calculation based on initial vital signs may be used as a screening tool and therefore incorporated into initial assessment protocols to manage trauma patients.