Trends of trauma team physicians toward patients with bleeding in Saudi Arabia: a cross-sectional study

Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients.

A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding. The surveys were administered in person to 135 TT physicians.

Among them, 38.52% had five or more years of independent practice, and 87.41% routinely encountered patients with bleeding patients. Physicians who routinely treated patients with bleeding patients exhibited higher median scores, in line with current management standards (p = 0.634). Tertiary care physicians and academic- and military-affiliated physicians exhibited higher median scores (p =  <0.001 and p < 0.006, respectively). Amongst TT physicians, 47.41% preferred EAE for unstable pelvic ring fractures with active bleeding, while 68.15% favored splenectomy for unstable patients with grade V splenic injuries. For traumatic aortic injuries, 67.42% considered TEVAR/EVAR safer options. Notably, 84.44% viewed an INR > 3 as a contraindication for EAE in hemodynamically stable patients. General surgeons scored the highest in management decision-making, followed by neurosurgeons (p = 0.001). Orthopedics, emergency medicine, intensive care (ICU), and anesthesia specialists exhibited similarly high median scores for appropriate management approaches (p = 0.003). Overall, general surgeons, orthopedic surgeons, and ICU specialists exhibited the highest median correct responses, adhering to the current standard of practice (p = 0.001).

To address the potentially life-threatening condition of traumatic bleeding, raising awareness of the appropriate management and referral patterns for EAE is crucial.