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

Figures & data

Table 1 Patterns of trauma injuries in 3,786 patients admitted to KAMC, Riyadh, Saudi Arabia

Characteristics	All (N=3,786, 100%)		Male (N=2,934, 77.5%)		Female (N=852, 22.5%)		Sex difference
	n	%	n	%	n	%	(χ^2, p-value)
Patients’ characteristics
Age (years)							42.16, <0.0001^a
0–5	447	11.8	269	9.2	178	11.8
6–14	449	11.9	338	11.5	111	13.0
15–25	1,130	29.8	1,027	35.0	102	12.0
26–45	974	25.7	803	27.4	171	20.1
46–64	386	10.2	257	8.8	129	15.1
65+	401	10.6	240	8.2	161	18.9
Mean (±SD)	29.62±21.62		28.4± 19.7		33.7±26.8		t=5.39, <0.001^a
Trauma characteristics
Mechanism of injury							256.21, <0.001^a
Burn/scald	258	6.8	160	5.5	98	11.5
MVCs	1,969	52.0	1,676	57.1	293	34.4
Falls	977	25.8	613	20.9	364	42.7
Intentional	193	5.1	183	6.2	10	1.2
Others	389	10.3	302	10.3	87	10.2
Team activation							91.82, <0.001^a
Not activated	2,950	77.9	2,184	74.4	766	89.9
Activated	836	22.1	750	25.6	86	10.1
Transportation							111.05, <0.001^a
Ambulance	1,518	40.2	1,291	44.2	227	26.7
Medevac	223	5.9	192	6.6	31	3.6
Private/police	2,031	53.9	1,438	49.2	593	69.7
Anatomical site^b
Head	1,218	32.2	1,044	35.6	174	20.4	69.85, <0.001^a
Chest	641	16.9	550	18.7	91	10.7	30.54, <0.001^a
Abdomen	338	8.9	293	10.0	45	5.3	17.97, <0.001^a
Extremities	2,322	61.3	1,777	60.6	545	64.0	3.22, 0.073
Disposition from ER							51.18, <0.001^a
Burn unit	192	5.1	123	4.2	69	8.1
ICU	490	12.9	405	13.8	85	10.0
Operating room	908	24.0	752	25.6	156	18.3
Ward	2,132	56.3	1,598	54.5	534	62.7
Morgue	64'	1.7	56	1.9	8	0.9
Need for ICU admission							14.35, <0.001^a
Yes	1,089	26.7	888	30.3	201	23.6
No	2,697	73.3	2,046	69.7	651	76.4
Trauma severity (ISS)
Mild (<9 points)	1,882	49.7	1,396	47.6	486	57.0	42.65, <0.001^a
Moderate (9-15 points)	1,143	30.2	884	30.2	259	30.4
Severe (>15 points)	759	20.1	652	22.2	107	12.6
ISS score (mean ± SD)	10.2± 11.2		10.8± 11.8		8.1 ±8.7		t=7.40, <0.001^a
GCS (mean ± SD)	13.4±3.6		13.1 ±3.7		14.2±2.6		t=9.43, <0.001^a
RTS (mean ± SD)	11.4± 1.2		11.4± 1.3		11.6±0.9		t=6.52, <0.001^a
LOS in ER (h)	14.7±20.0		15.1 ±20.6		13.4± 17.6		t=2.36, 0.019^a
LOS in ICU (days)	4.7± 14.5		4.9±15.1		4.1 ± 12.1		t= 1.51, 0.13
LOS in hospital (days)	19.8±44.1		20.5±46.6		17.6±34.3		t= 1.96, 0.05

Notes: ^aStatistical significance.

b Categories are not mutually exclusive.

c This figure includes 40 dead on arrival.

Abbreviations: ER, emergency room; GCS, Glasgow Comma Scale; ICU, intensive care unit; ISS, Injury Severity Score; KAMC, King Abdulaziz Medical City; LOS, length of stay; MVCs, motor vehicle crashes; RTS, Revised Trauma Score.

Figure 1 Distribution of mechanisms of traumatic injuries by sex and age groups.

Abbreviation: MVCs, motor vehicle crashes.

Figure 2 Association between the severity of injury and mechanisms of traumatic injuries by sex.

Abbreviation: MVCs, motor vehicle crashes.

Table 2 Inhospital mortality rates in trauma patients admitted to KAMC, Riyadh, Saudi Arabia

Characteristics	Dead, n (%)	Case fatality rate (per 100 injured)
		Male	Female	Overall	p-value
Total	178 (100)^a	5.1	3.7	4.8	0.09
Age (years)
0–5	11 (6.2)	2.3	2.5	2.5	0.76^b
6–14	14 (7.9)	3.0	3.2	3.1	0.76^b
15–25	47 (26.4)	4.1	4.2	4.2	0.61^b
26–45	57 (32.0)	6.7	5.9	5.9	0.029
46–64	19 (10.7)	5.9	4.9	4.9	0.24
65+	30 (16.8)	8.8	7.5	7.5	0.24
χ^2, p-value		17.86, <0.001	3.43, 0.63	17.51, 0.004
Mechanism of injury
MVCs	119 (66.9)	6.4	4.5	6.1	0.20
Burn/scald	25 (14.0)	10.7	8.2	9.7	0.44
Falls	24 (13.5)	2.6	2.2	2.5	0.69
Intentional	5 (2.8)	1.6	22.2	2.6	0.018^b
Other	5 (2.8)	1.7	0.0	1.3	0.59^b
χ^2, p-value		35.84, <0.001	20.41, <0.001	45.41, <0.001
Anatomical site^c
Head/neck/face	124 (69.7)	10.5	8.0	10.2	0.31
Chest	59 (33.1)	9.3	8.8	9.2	0.88
Abdomen	28 (15.7)	8.5	6.7	8.3	0.67
Extremities	86 (48.3)	4.1	2.4	3.7	0.06
Team activation
Not activated	62 (34.8)	1.9	2.6	2.1	0.27
Activated	116 (65.2)	14.1	12.8	14.0	0.74
χ^2, p-value		169.60, <0.001	22.63, <0.001	200.03, <0.001
Transportation
Ambulance	123 (69.1)	8.0	9.5	8.2	0.48
Medevac	30 (16.8)	15.1	6.5	13.9	0.20
Private/police	25 (14.1)	1.2	1.3	1.2	0.76
χ^2, p-value		106.64, <0.001	30.81, <0.001	135.09, <0.001
Disposition from ER
Burn unit	16 (9.0)	8.1	8.7	8.3	0.89
ICU	46 (25.8)	9.6	8.2	9.4	0.69
Operating room	74 (41.6)	8.9	4.5	8.1	0.07
Ward	18 (10.1)	0.6	1.5	0.8	0.10^b
χ^2, p-value		501.63, <0.001	96.36, <0.001	604.88, <0.001
Need for ICU admission
Yes	137 (97.0)	13.0	10.9	12.6	0.72
No	41 (3.0)	1.6	1.4	1.5	0.44
χ^2, p-value		165.12, <0.001	39.67, <0.001	207.91, <0.001
Trauma severity (ISS)
Mild (<9 points)	3 (1.7)	0.1	0.2	0.2	1.0^b
Moderate (9-15 points)	16 (9.0)	1.0	2.7	1.4	0.07^b
Severe (>15 points)	159 (89.3)	22.0	22.5	22.1	0.91
χ^2, p-value		469.46, <0.001	120.33, <0.001	594.66, <0.001
GCS
<8 “in coma”	115 (64.6)	25.6	28.9	25.9	0.63
9+ “out of coma”	63 (35.4)	1.8	2.2	1.9	0.42
χ^2, p-value		403.67, <0.001	85.79, <0.001	497.80, <0.001
RTS
<3 “no care”	0 (0.0)	0.0	0.0	0.0	-
3-10 “immediate care”	119 (68.0)	22.4	20.0	22.1	0.66
11 “urgent”	19 (10.9)	4.4	2.4	3.9	0.33
12 “can be delayed”	37 (21.1)	1.1	2.1	1.4	0.08
χ^2, p-value		367.17, <0.001	55.76, <0.001	434.95, <0.001

Notes: ^aThis figure does not include dead on arrival.

b Fisher’s exact test was applied.

c Categories are not mutually exclusive.

Abbreviations: ER, emergency room; GCS, Glasgow Comma Scale; ICU, intensive care unit; ISS, Injury Severity Score; KAMC, King Abdulaziz Medical City; MVCs, motor vehicle crashes; RTS, Revised Trauma Score.

Table 3 Predictors of inhospital mortality among trauma-injured patients

Factor	Case fatality (RR)	95% LCL	95% UCL	p-value
Female vs. male	1.096	0.930	1.292	0.274
Age in 10 years	1.174	1.139	1.209	<0.001
Injury severity
Moderate vs. mild	6.438	4.037	10.267	<0.001
Severe vs. mild	181.780	116.880	282.716	<0.001
Mechanism of injury
Falls vs. MVCs	2.337	1.865	2.929	<0.001
Burn/scald vs. MVCs	1.728	1.433	2.085	<0.001
Intentional vs. MVCs	1.221	0.847	1.759	0.285
Others vs. MVCs	0.282	0.575	1.175	0.511

Abbreviations: LCL, lower confidence limit; MVCs, motor vehicle crashes; RR, rate ratio; UCL, upper confidence limit.