title: In-hospital mortality among patients injured in motor vehicle crashes in a Saudi Arabian hospital relative to large U.S. trauma centers.
abstract: BACKGROUND
  Traffic-related fatalities are a leading cause of premature death worldwide. According to the 2012 reportthe 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.
authors.affiliation: Postdoctoral Researcher, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Suliman
authors.initials: S
authors.lastname: Alghnam
authors.affiliation: Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA.
authors.forename: Mari
authors.initials: M
authors.lastname: Palta
authors.affiliation: Emergency Medicine, University of Wisconsin-Madison, Madison, WI USA.
authors.forename: Azita
authors.initials: A
authors.lastname: Hamedani
authors.affiliation: Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Remington
authors.affiliation: Research Scientist, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alkelya
authors.affiliation: Consultant Surgeon, Department of Surgery, King Abdulaziz Medical City, Riyadh Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Albedah
authors.affiliation: Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA.
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Durkin
keywords: Comparison; In-hospital; Mortality; Motor vehicle; Saudi Arabia