Impact of Trauma System Implementation on Mortality Rate in Alahsa, Saudi Arabia: A Retrospective Comparative Study
Keywords:
Trauma System, Alhasa city, Saudi ArabiaAbstract
Introduction: Trauma is leading cause of morbidity and mortality worldwide, with major public health burden in Saudi Arabia. Although structured trauma systems improve outcomes internationally, their impact in the Kingdom remains insufficiently evaluated. This study assessed effect of trauma system implementation in the Alahsa Health Cluster.
Methods: retrospective study was conducted at King Fahad Hospital, Level I trauma center in Alahsa, Saudi Arabia. Trauma registry data from the pre-implementation (2017–2018) and post-implementation (2022–2023) periods were analyzed. Eligible patients had an Injury Severity Score (ISS) ≥15 and hospital stay >24 hours. Variables included demographics, injury mechanism and site, length of stay, and in-hospital mortality. Comparisons were performed using chi-square and Mann–Whitney U tests. Multivariable logistic regression estimated adjusted odds ratios for mortality after adjustment for age, injury mechanism, and ISS.
Results: total of 631 patients were included (mean age 31.8 years; 87.3% male). Crude in-hospital mortality declined from 19.0% (70/368) before implementation to 16.3% (43/263) afterward (p = 0.011). However, study period was not independent predictor of mortality after adjustment (AOR = 0.97, 95% CI: 0.45–2.10; p = 0.945). Independent predictors of mortality were ISS (AOR = 1.22; p < 0.001) and age (AOR = 1.04; p < 0.001). Motor vehicle accidents decreased from 58.4% to 41.6% (p < 0.001), with significant reductions in head, face, and neck injuries. Mortality decreased among adults but not children.
Conclusion: Implementation regional trauma system was associated with reduction in mortality and favorable shifts injury patterns. However, multivariable analysis suggests that the observed improvement was primarily driven by variations in patient case-mix and baseline injury severity rather than a standalone systemic effect. These findings emphasize necessity of rigorous case-mix adjustment in trauma research and support integration of trauma registries, pediatric-specific pathways, and enhanced subspecialty coverage to consolidate improvements and guide national expansion under Vision 2030.
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