Trauma care systems in Saudi Arabia: an agenda for action

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.

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.

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.

Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants’ demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group’s time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6–20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.

Traumatic Brain Injury: A Perspective on the Silent Epidemic

Background: Epidemiological data regarding the causes, patterns, severity, and outcomes of traumatic brain injury (TBI) are essential to plan for preventive strategies addressing this public health epidemic. The main aim of this study is to explore the patterns and causes of traumatic brain injury at two trauma centers.

Methods: A retrospective cohort study was conducted using a pre-tested validated data collection sheet. Data were collected from the medical records and electronic database of patients who presented to the emergency department with head trauma. Variables including the mechanisms, patterns of the injury, accompanying injuries, level of consciousness, and hospitalization duration were investigated for any possible association.

Results: A total of 269 patients (78% males, 22% females) who satisfied our study criteria were included in the final analysis. Motor vehicle collisions were the most common reason for traumatic brain injury (57.6%) followed by falls (28.3%). There was a statistically significant association observed between type of hemorrhage and Glasgow coma scale at initial presentation (P < 0.05). 

Conclusion: The most common cause of traumatic brain injury is motor vehicle collisions, followed by falls. The public should be made aware of the importance of using safety and precautionary measures to minimize the impact of traumatic brain injuries. Educational programs for neurotrauma prevention can be developed and utilized as a blueprint for local hospitals and officials in the country.

Negative Whole-Body Computed Tomography Scans in Polytrauma Patients: A Retrospective Cohort Study

Background

Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients.

Patients and Methods

A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients.

Results

A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans.

Conclusion

Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.

The prevalence of head and facial injuries among children in Saudi Arabia following road traffic crashes

BACKGROUND

Motor vehicle crashes (MVCs) are the leading cause of death among children in Saudi Arabia. Childhood injuries can be prevented or minimized if safety measures, such as car seats, are implemented. The literature on the epidemiology of head and facial injury among children is limited, which affects the ability to understand the extent of the burden and hinders investment in public health prevention.

OBJECTIVE

Describe the epidemiology of head and facial injuries among children admitted to the hospital following MVCs.

DESIGN

Retrospective chart review.

SETTING

Five hospitals in several regions.

PATIENTS AND METHODS

We collected data on all patients ≤16 years old, who were admitted to the hospital following MVCs between 2016-2019. Differences in various characteristics like head injury status and age groups were compared.

MAIN OUTCOME MEASURES

Head and facial injuries.

SAMPLE SIZE

253 patients.

RESULTS

Of the injured population, 97 (38.3%) sustained a head injury, and 88 (34.8%) had a facial injury. Thirteen (9.1%) children were driving the car at the time of the crash. About half of the children were seated in the back (53.8%) without a seatbelt or safety seat.

CONCLUSION

The prevalence of head and facial injuries is striking. In addition, the study revealed that driving among children is not uncommon, which warrants monitoring and implementing interventions. Improved documentation of restraint use and police enforcement of safety laws can play a significant role in reducing associated injuries. The study findings highlight the importance of combination or rear seating as well as age-appropriate restraint in order to reduce the likelihood of head or facial injuries among children.

LIMITATIONS

Retrospective study using the electronic search system to identify patients, but may have missed cases that were not coded correctly. Large amount of missing data for some variables. Additionally, the analysis was limited to those admitted to the hospital.

CONFLICT OF INTEREST

None.

Experience gained from the implementation of the Saudi TraumA Registry (STAR)

Background

Trauma registries are essential to trauma systems, to enable collection of the data needed to enhance clinical knowledge and monitor system performance. The King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi Arabia (KSA) is aiming to become a Level 1 Trauma Centre, and required a trauma registry in order to do so. Our objective was to establish the Saudi TraumA Registry (STAR) at the (KSMC) and ready it for national deployment. The challenge was that no formal trauma data collection had occurred previously and clinicians had no prior experience of trauma registries.

Methods

To develop the registry, a novel 12 step implementation plan was created and followed at the KSMC. Registry criteria and a Minimum Dataset were selected; training was delivered; database specifications were written; operating procedures were developed and regular reporting was initiated.

Results

Data collection commenced on August 1st 2017. The registry was fully operational by April 2018, eight months ahead of schedule. During the first year of data collection an average of 216 records per month were entered into the database. An inaugural report was presented at the Saudi Trauma Conference in February 2019.

Conclusions

The strategy deployed at the KSMC has successfully established the STAR. In the short term, process indicators will track the development of the hospital into a Level 1 Trauma Centre. In the medium to long term the STAR will be rolled out nationally to capture the impact of public health initiatives aimed at reducing injury in the KSA. The effect of the STAR will be that the country is better equipped to deliver continuous improvements in trauma systems and quality of care.

Epidemiology of hand fractures at a tertiary care setting in Saudi Arabia

Objectives:

To examine the epidemiology of hand fractures including common bones affected, causes, interventions, outcomes, and complications.

Methods:

This retrospective records-based study included patients who were admitted to King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, with traumatic metacarpal or phalangeal fractures between January 2016 and September 2017. Carpal fractures, wrist fractures, and all pathological fractures were excluded.

Results:

A total of 82 patients (90.2% of them men with an average age of 27.6±13.4 years) with 101 fractures were included. The fifth (25.5%) and first (24.5%) rays were the most commonly affected ones. The fifth finger (27.8%) and first metacarpal (28.9%) were the most commonly affected finger and metacarpal bone. Approximately 32.7% of the fractures were open fractures. The most frequent causes of hand fractures included falls (40.5%), road traffic accidents (20.3%), crushing injuries (9.5%), and machinery injuries (9.5%). Approximately 90.1% of the patients underwent operative interventions including open reduction (50.5%) and closed reduction (34.3%). The majority of fractures (79.2%) healed, and only 14.7% of fractures developed complications.

Conclusion:

In this study of hand fractures, patients were predominantly males and the main causes of fractures were falls and road traffic accidents.

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.

Pediatric Trauma Boot Camp: A Simulation Curriculum and Pilot Study

Trauma is a leading cause of morbidity and mortality in infants and children worldwide. Trauma education is one of the most commonly reported deficiencies in pediatric emergency medicine (PEM) training. In this study, we describe the creation of a pediatric trauma boot camp in which trainees' basic knowledge, level of confidence, teamwork, and communication skills are assessed. The primary goal of this pilot study was to create a simulation-based pediatric trauma curriculum for PEM fellows and emergency medicine residents utilizing Kern's curricular conceptual framework. This was a pilot, prospective, single cohort, exploratory, observational study utilizing survey methodology and a convenience sample. The curriculum consisted of a two-day experience that included confidence surveys, a cognitive multiple-choice questionnaire, and formative and summative simulation scenarios. At the conclusion of this intensive simulation-based trauma boot camp participants reported increased confidence and demonstrated significant improvement in the basic knowledge and performance of the management of pediatric trauma cases in a simulated environment.

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.

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..

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

OBJECTIVES

To identify the changing trends and crucial preventive approaches to road traffic accidents (RTAs) adopted in the Kingdom of Saudi Arabia (KSA) over the last 2.5 decades, and to analyze aspects previously overlooked.

METHODS

This systematic review was based on evidence of RTAs in KSA. All articles published during the last 25 years on road traffic accident in KSA were analyzed. This study was carried out from December 2013 to May 2014 in the Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawwarah, KSA.

RESULTS

Road traffic accidents accounted for 83.4% of all trauma admissions in 1984-1989, and no such overall trend was studied thereafter. The most frequently injured body regions as reported in the latest studies were head and neck, followed by upper and lower extremities, which was found to be opposite to that of the studies reported earlier. Hospital data showed an 8% non-significant increase in road accident mortalities in contrast to police records of a 27% significant reduction during the years 2005-2010. Excessive speeding was the most common cause reported in all recent and past studies.

CONCLUSION

Disparity was common in the type of reporting of RTAs, outcome measures, and possible causes over a period of 2.5 decade. All research exclusively looked into the drivers' faults. A sentinel surveillance of road crashes should be kept in place in the secondary and tertiary care hospitals for all regions of KSA.

Out-of-hospital adult cardiac arrests in a university hospital in central Saudi Arabia

Objectives:

To report the characteristics of adult out-of-hospital arrest patients and their outcomes in Riyadh, Saudi Arabia.

Methods:

This is a prospective descriptive study of out-of-hospital adult arrests incident transported to King Khalid University Hospital, Riyadh, Saudi Arabia between July 2012 and September 2013.

Results:

A total of 96 adult patients were enrolled in this study. Males represented 62.5% of the participants. The mean age of the study population was 58.9 years, and specifically 30.8 years for traumatic arrests, and 62.9 for non-traumatic. An over-all mortality rate of 95.8% was documented, as well as a low rate of bystander cardiopulmonary resuscitation being performed, and a family member transported most patients to the hospital.

Conclusion:

A low survival rate for non-traumatic out-of-hospital adult arrest patients and a 100% mortality rate in traumatic arrests were discovered.

Road Traffic Injury as a Major Public Health Issue in the Kingdom of Saudi Arabia: A Review

Injury was the largest single cause of disability-adjusted life years and death in the Kingdom of Saudi Arabia in 2013. The vast majority of injury-related fatalities are deaths caused by road traffic. Measures to control this serious public health issue, which has significant consequences for both Saudi families and the Saudi economy as a whole, have been underway for years but with little success. Most attempts at intervening revolve around attempts for enforcing stricter traffic laws and by installing automated traffic monitoring systems that will catch law breakers on camera and issue tickets and fines. While there has been much research on various factors that play a role in the high rate of road traffic injury in The Kingdom (e.g., driver behavior, animal collisions, disobeying traffic and pedestrian signals, environmental elements), virtually no attention has been given to examining why Saudi drivers behave the way that they do. This review provides a thorough account of the present situation in Saudi Arabia and discusses how health behavior theory can be used to gain a better understanding of driver behavior.

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.

Trauma patterns in patients attending the Emergency Department of Jazan General Hospital, Saudi Arabia

BACKGROUND

Modern civilization and the sharp rise in living standards have led to dramatic changes in trauma pattern in Saudi Arabia. This study aimed to describe the different patterns of injuries of patients attending the Emergency Department of Jazan General Hospital (JGH) in the southwest corner of Saudi Arabia.

METHODS

A total number of 1 050 patients were enrolled in the study. A pre-organized data sheet was prepared for each patient attended the Emergency Department of JGH from February 2012 to January 2013. It contains data about socio-demographics, trauma data, clinical evaluation results, investigations as well as treatment strategies.

RESULTS

The mean age of the patients was 25.3±16.8 years. Most (45.1%) of the patients were at age of 18-30 years. Males (64.3%) were affected by trauma more common than females. More than half (60.6%) of the patients were from urban areas. The commonest kind of injury was minor injury (60%), followed by blunt trauma (30.9%) and then penetrating trauma (9.1%). The mean time from the incident to arrival at hospital was 41.3±79.8 minutes. The majority (48.2%) of the patients were discharged after management of trivial trauma, whereas 2.3% were admitted to ICU, 7.7% transferred to inpatient wards, and 17.7% observed and subsequently discharged. The mortality rate of the patients was 2.6%.

CONCLUSION

Trauma is a major health problem, especially in the young population in Saudi Arabia. Blunt trauma is more frequent than penetrating trauma, with road traffic accidents accounting for the majority.

In-hospital mortality among patients injured in motor vehicle crashes in a Saudi Arabian hospital relative to large U.S. trauma centers

Background

Traffic-related fatalities are a leading cause of premature death worldwide. According to the 2012 report the Global Burden of Disease 2010, traffic injuries ranked 8th as a cause of death in 2010, compared to 10th in 1990. Saudi Arabia is estimated to have an overall traffic fatality rate more than double that of the U.S., but it is unknown whether mortality differences also exist for injured patients seeking medical care. We aim to compare in-hospital mortality between Saudi Arabia and the United States, adjusting for severity and demographic variables.

Methods

The analysis included 485,611 patients from the U.S. National Trauma Data Bank (NTDB) and 5,290 patients from a trauma registry at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. For comparability, we restricted our sample to NTDB data from level-I public trauma centers (≥400 beds) in the U.S. Multiple logistic regression analyses were performed to evaluate the effect of setting (KAMC vs. NTDB) on in-hospital mortality after adjusting for age, sex, Triage-Revised Scale (T-RTS), Injury Severity Score (ISS), mechanism of injury, hypotension, surgery and head injuries. Interactions between setting and ISS, and predictors were also evaluated.

Results

Injured patients in the Saudi registry were more likely to be males, and younger than those from the NTDB. Patients at the Saudi hospital were at higher risk of in-hospital death than their U.S. counterparts. In the highest severity group (ISSs, 25–75), the odds ratio of in-hospital death in KAMC versus NTDB was 5.0 (95% CI 4.3-5.8). There were no differences in mortality between KAMC and NTDB among patients from lower ISS groups (ISSs, 1–8, 9–15, and 16–24).

Conclusions

Patients who are severely injured following traffic crash injuries in Saudi Arabia are significantly more likely to die in the hospital than comparable patients admitted to large U.S. trauma centers. Further research is needed to identify reasons for this disparity and strategies for improving the care of patients severely injured in traffic crashes in Saudi Arabia.

Electronic supplementary material

The online version of this article (doi:10.1186/s40621-014-0021-4) contains supplementary material, which is available to authorized users.

Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh, Saudi Arabia

BACKGROUND AND OBJECTIVES

In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA.

DESIGN AND SETTINGS

Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA.

PATIENTS AND METHODS

A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group ( 14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated.

RESULTS

10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P < .001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%).

CONCLUSION

This registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.

Trauma profile at a tertiary intensive care unit in Saudi Arabia

BACKGROUND AND OBJECTIVES

Trauma is a leading cause of death worldwide and in Saudi Arabia. This study describes the injury profiles and ICU outcomes of patients in a tertiary trauma care referral center in Riyadh, Saudi Arabia.

DESIGN AND SETTING

A retrospective analysis of ICU data collected prospectively over 5 years in a 21-bed medical and surgical intensive care unit (ICU) in a tertiary care teaching hospital.

PATIENTS AND METHODS

We collected ICU data on all patients admitted secondary to motor vehicle accidents (MVAs), excluding patients younger than 18 years, brain dead patients and readmissions. We collected data on age, gender, and Glasgow coma scale score at admission, injury severity scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and other data. Multivariate logistic regression was used to identify predictors of mortality.

RESULTS

During the study period, of 1659 patients, MVA was the most common cause of injury (78.4%), followed by pedestrian accident (12.7%). ICU mortality included 221 patients (13.3%) during the study period. Severe head injury, age > 60 years, Glascow coma scale score, injury severity scores, APACHE II and international normalized ratio were independent predictors of mortality.

CONCLUSION

MVA is very common in our country and leads to significant mortality and morbidity. Public education and strict law enforcement are needed to reduce these adverse events.