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

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.

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.

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).

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.