Early Impact of a Dedicated Trauma Surgery Unit on Outcomes in a Malaysian Tertiary Center

Trauma remains a major cause of mortality worldwide, particularly in low- and middle-income countries. Organized trauma systems and dedicated trauma services have been associated with improved outcomes; however, data from Southeast Asia remain limited. This study evaluated the impact of establishing a dedicated Trauma Surgery Unit (TSU) at a Malaysian tertiary referral center.

A single-center observational study was conducted at Hospital Tuanku Ja'afar Seremban, Malaysia, comparing trauma patients managed before TSU establishment (April-June 2024) and after implementation (July 2024-December 2025). Outcomes included epidemiology, operative workload, solid organ injury management, and mortality. Trauma system interventions introduced during the study included a trauma registry, structured Trauma Team Activation (TTA) criteria, institutional trauma protocols, and a Massive Transfusion Protocol (MTP). Statistical analyses were performed using Chi-square, Fisher's exact, and Student's t-tests.

A total of 1038 trauma patients were included (128 pre-unit; 910 post-unit). Blunt trauma accounted for 97.0% of injuries, with road traffic crashes comprising 90.7%. Major trauma (ISS > 15) represented 53.7% of admissions. Following TSU establishment, overall mortality decreased from 17.2% to 7.6% (p < 0.001), while mortality among major trauma patients decreased from 24.4% to 13.8% (p < 0.001). A total of 114 operative procedures were performed, including 67 laparotomies, with a non-therapeutic laparotomy rate of 4.5%. Among 197 blunt solid organ injuries, non-operative management was successful in 94.3% of cases.

Lower overall and major trauma mortality rates were observed following the establishment of a dedicated Trauma Surgery Unit and implementation of structured trauma system initiatives. While causality cannot be inferred from this observational study, the findings support continued development and evaluation of organized trauma services in Malaysia and other middle-income healthcare settings.