Rollover motor vehicle crashes and occupant ejection: comparative analysis from a Middle Eastern trauma center

Rollover motor vehicle crashes (ROCs) and occupant ejection (OE) are associated with worse outcomes. We studied the incidence, predictors, injury patterns, and outcomes of ROCs and OE in a rapidly developing country.

This was a retrospective analysis of the Qatar National Trauma Registry (2013-2024). Patients were grouped as ROCs with ejection (Group I), ROCs without ejection (Group II), and ejection without ROC (Group III). We applied the Haddon Phase-Factor Matrix.

2,764 patients were analyzed into Group I (n = 908; 32.9%), Group II (n = 1,626; 58.8%), and Group III (n = 230; 8.3%). Group I was younger than Groups II and III (p = 0.001). Seatbelt use was lower in Group I (5.0%) than in Groups II (32.0%) and III (8.6%; p = 0.001). Airbag deployment was higher in Groups I and II (5.7% and 6.6%) than in Group III (3.5%). Lethal injuries (Injury Severity Score: ISS ≥25) were more common in Group I (24.4%) and Group III (19.1%) than in Group II (8.6%). Intubation, massive transfusion, hospital length of stay, and mortality were significantly higher in the ejected Groups. The declared dead-on-arrival rate was 11.7% in Group III, 8.1% in Group I, and 2.3% in Group II. Overall mortality rates were 20.9% in Group III, 15.0% in Group I, and 4.4% in Group II. OE increased tenfold if the seatbelt was not used and was associated with a fourfold increase in mortality. After adjustment for age, sex, seatbelt use, position in the vehicle, and speed, seatbelt not used remained a predictor of OE (OR 6.80; 95% CI 5.000-9.259), along with age, driver, front-seat passenger, and car speed. However, data on the car's speed prior to the accident remained questionable. Therefore, the speed variable was excluded from the second multivariable analysis, which revealed that seatbelt use was associated with 85% reduction in the probability of OE. Predictors of mortality were female sex (OR 2.92; 95% CI 1.321-6.451), massive transfusion protocol activation (OR 3.87; 95% CI 2.162-6.932), Glasgow Coma Scale at the scene (OR 1.29; 95% CI 1.206-1.381), and intubation.

ROCs and OE are associated with high mortality rates in young patients. Framed within the HM, these findings highlight critical pre-event and event-phase intervention points. Strictly enforcing seatbelt compliance is essential because nonuse increases ejection risk tenfold and raises the likelihood of lethal injuries. Targeted road-safety campaigns focused on car rollover prevention are recommended for younger drivers to reduce elevated car-occupant mortality rates.