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Original Research (Original Article) 


Yasir Elshambaty et al, 2019;3(8):694–698.

International Journal of Medicine in Developing Countries

An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia

Yasir Elshambaty1,2*, Abdulmajeed Alzahrani1, Aimun AbdulGafar1,3, Bader Alzahrani1, Waleed Shahwan1, Abdullah AlFalah1

Correspondence to: Yasir Elshambaty

*Department of surgery, Faculty of Medicine, Albaha University, AlBaha, Saudi Arabia.

Email: yasiralshambaty [at] gmail.com

Full list of author information is available at the end of the article.

Received: 14 February 2019 | Accepted: 20 March 2019


ABSTRACT

Background:

According to WHO, the number of road traffic deaths approximates 1.25 million in 2013. Road traffic accident (RTA) is the leading cause of death in individuals aged between 15- and 29-year old and male subjects are studied to be more involved in RTA than females. The current study aims at assessing the effects of RTA on the families living in Al-Baha region of Saudi Arabia.


Methodology:

A cross-sectional study was performed during the period between May and July 2018 assessing RTA impacts on families residing at Al-Baha region, Saudi Arabia. A structured questionnaire was employed and direct interviews of the householder or someone (his/her) own behalf was carried out. The results were analyzed by using Statistical Package for the Social Sciences version 25.


Results:

The total number of families assessed in the current study was 104, including 516 individuals. Among the total, 110 subjects were involved in RTA. The injured subjects after RTA (110) corresponded to 64 different families. Male subjects were involved in RTA more than female subjects with a ratio of 2.1:1. Mortality was found to be 6.36% and disability was 6.36%. Death was reported more commonly in pediatrics 42.8%, whereas the disability was common in those aged between 18 and 30 years was 42.8%. The most common injury site was head and neck (42.8%). The major cause for RTA in the studied population was found to be the high speed (44.54%) followed by fog (23.6%).


Conclusion:

The current study reported the mortality to be higher in children and in males among the studied subjects. The major cause for RTA in the studied population was found to be the high speed. The Fog was the second common cause of RTA and this was very unusual and not expected in a country like Saudi Arabia.


Keywords:

Road traffic injury, road traffic accident, household, fog.


Introduction

According to WHO, the number of road traffic deaths approximates 1.25 million in 2013. Road traffic accident (RTA) is the leading cause of death in individuals aged between 15- and 29-year old and male subjects are studied to be more involved in RTAs than females. The main cause of RTA is reported to be the high speed of vehicles. About 73% of all road traffic deaths occur among young males under the age of 25 years, who are almost three times as likely to be killed in a road traffic crash as young females. RTA is a serious problem, especially in Saudi Arabia that results in a high mortality and morbidity rate. The car is the main transportation in Kingdom of Saudi Arabia (KSA), which occupies the fifth largest state in Asia (in terms of car usage), in addition to the continuous increase in the number of vehicles due to the changing socioeconomic status and lifestyle. The accidents rate according to Traffic police statistics in 2017 in Saudi Arabia was 460,488 which resulted in 3,199 injuries and 7,489 death [1]. Recent data on car accidents in the first quarter of 2018 stated that there are 107,637 accidents reported with 7,776 injuries and 1,649 deaths in Saudi Arabia [1]. Non-communicable diseases and road traffic injuries were reported as the leading cause of death and disability in KSA in a study conducted in 2010 [2]. Road traffic injury (RTI) forms an economic burden to hospitals, as the accident subject needs special care and may need a long time for recovery [3]. A survey conducted in Al Qassim region, KSA, showed that nearly 1 in 14 people reported non-fatal RTI annually requiring a recovery period of >7 days, and nearly 1 in 7 people reported non-fatal RTI annually requiring a recovery period of >7 days [3]. RTI also results in different disorders, including loss of physical capacity, social problems, and helplessness and most of these disorders remain lifelong. Al-Baha which forms the smallest region in KSA (11,000 km2), with a high altitude about 2,155 m above the sea level. It consists of six provinces, the most important ones are Bulgurashi, Almandaq, in addition to the Al Baha city in the center of the region. It has a population of 533,001. RTA in Al-Baha is common because of its rough terrain, in addition to the climate that is mainly rainy and foggy. The rain season in Al-Baha region begins in October to February characterized by rainfall and fog. Many studies have reported the adverse effects of the rain on RTA which results in an increased rate of crashes. Fog leads to poor visibility on roads leading to RTA [46]. In Al-Baha region, the accident rate was 355, with 212 injury and 32 deaths which form (6.67%) of all car accidents in Saudi Arabia reported during the first quarter of 2018 [1]. The major risk factor of RTAs was found to be the high speed as reported by many studies [79]. Mobile use during driving also has been reported to increase the RTA [10]. Another study found that making or receiving phone calls while driving was accompanied by seven times greater relative risk of RTI involvement among drivers in Saudi Arabia than those who did not [11]. The most common site of injury was found differences among the different studies. Some studies reported head and neck as the most vulnerable site, while some reported say upper limbs as the common site of injury. Furthermore, another study mentioned common injury site as the head and neck, limbs, and trunk [12]. Studies regarding different patterns of RTI and its impacts on the social life in Al-Baha region are very limited.


Subjects and Methods

A cross-sectional study was performed during the period between May and July 2018 in the form of a household-based survey assessing RTA impacts in families residing at Al-Baha region, Saudi Arabia. A structured questionnaire was employed and direct interviews of the householder or someone his/her own behalf was carried out. The study population included all the Saudi families that willing to participate in the survey. Exclusion criteria included non-Saudi families. The results were analyzed by using Statistical Package for the Social Sciences version 25.


Results

This study was conducted in Al-Baha province in Saudi Arabia. The total number of families included in the study was 104. Sixty-four (54%) of families had at least one traumatized member and 46 (44%) family had no one with sustained trauma due to RTA. The total population of the 104 families included in the study was 516 person with an average family size of 4.96 individual. The number of male subjects was 279 (54.1%) and the female was 237 (45.9%) as shown in Table 1. The distribution of the participants according to the age is represented in Table1. Among the studied subjects, one third were children and 40% of the participants belonged to the age group between 18 and 30 years. The number of participants who were injured due to the involvement in RTA were 110 among 516 subjects and this constitutes about one fifth (21.32%) of the total studied population. The number of injured individuals was distributed in 64 families with a mean of 1.56 individual/family. The majority of traumatized participants were in the age group of 18–30 years and the least involved in RTA were those above 50 years of age (Figure 1). Male subjects were more involved in RTA than female among the studied subjects with a ratio of 2.1:1. The cause of RTA was attributed to high speed in about 44.54%, bad/foggy weather in 23.64%, and the use of phone during driving in 16.36% as shown in Table 2. Those who had been traumatized suffered from injuries, including laceration (32.73%), fractures (23.4%), and blunt trauma (37.27%). Seven (6.36%) out of 110 participants was found died. Figure 2A shows the site of the injury. In one-fourth of cases, the site of trauma was head and neck, and among more than one-third of the cases, the location of the trauma was the upper limb. Furthermore, among 23.64% of subjects, the location of the trauma was multiple in nature. Concerning the hospitalization of the injured patients, nearly 60% of them did not require hospitalization and 40% were admitted to the hospital. Only 10% required admission for more than 3 days. Eighty percent (80%) of those who attended the hospital did not need surgical intervention or intensive care unit (ICU) admission. Around 13% had undergone a surgical procedure and only 6.36% were admitted to ICU. The trauma outcome in those involved in RTA was as following: a total of seven (6.36%) patients died due to trauma. Among the seven who died, three (42.86%) were female and the other four (57.14%) were male. Three (42.8%) out of the seven who died were in age group less than 18-year old and two (28.6%) were in age group 18–30-year old, as displayed in Table 2. Furthermore, seven (6.36%) subjects ended up with a permanent disability. Of these seven subjects who developed a disability, only one was female and the remaining six were males. The rest of the subjects, 87.27% recovered completely from their injury. The disability was common in those between 18 and 30 years of age. The cause of the disability was head trauma in 42.86%, upper limb trauma in 14.3%, and lower limb 14.3% of the subjects. The spine injury with paralysis occurred in 28.6% of the subjects (Figure 2B).

Table 1. Demographic characteristics of the families members (n = 516).

Variable Subgroup Frequency (%)
Sex Male 279 (54.1)
Female 237 (45.9)
Age <18-year old 169 (32,8)
18–30-year old 208 (40.3)
31–50-year old 103 (20.0)
>50-year old 36 (7.0)
Families There is (are) a traumatized member. 64 (56)
There no traumatized member 46 (44)

Figure 1. The age distribution of the participants (n = 516).

Table 2. Characteristics of traumatized patients (n = 110).

Variable Subgroup Frequency (%)
Family member Traumatized

110 (21.32)

Non-traumatized 416 (78.68)
Cause of the trauma High speed

49 (44.54)
Bad weather (fog)

26 (23.64)
Phone

18 (16.36)
Others 17 (15.45)
Pattern of the trauma Laceration 36 (32.73)
Fracture 26 (23.64)
Blunt 41 (37.27)
Death 7.0 (6.36)
Site of injury Head/neck 29 (26.36)
Upper limb 41 (37.27)
Lower limb 14 (12.73)
Multiple 26 (23.64)
Hospitalization requirement No need 65 (59.0)
<24 hours 21 (19.0)
1–2 days 13 (11.82)
≥3 days 11 (10)
Procedure need No need 88 (80.0)
Surgery 15 (13.63)
ICU 7.0 (6.36)
An Outcome of trauma Complete recovery 96 (87.27)
Disability 7 (6.36)
Death 7 (6.36)
Death Male 4 (57.14%)
Female 3 (42.86%)
Disability cause Head 3 (42.86)
Upper limb 1 (14.3)
Lower limb 1 (14.3)
Paralysis 2 (28.6)

Discussion

The present study was a household survey to show the impact of RTI on the families residing at Al-Baha province in Saudi Arabia. The present study included all the household members regardless of their age or sex. More than 50% of the surveyed families included at least more than one injured person. This reflects the magnitude of RTA in the studied population where few subjects even had serious injuries. According to our knowledge, there has been no similar study conducted in other areas of Saudi Arabia demonstrating the number of householders who are involved in RTA. Most of the studies on RTA has reported the number of males exceeding than that of the females in the respective surveyed families. The total number of the individuals involved in RTA and resulting injured were 110 out of 516 (21%). This means that at least one out of five persons remained injured in Al-Baha region due to RTAs regardless of the severity of the injury. The most frequent age group involved in RTIs were the young adults aged between 18 and 30 years. Males were involved in RTI more than the female study subjects with a ratio of 2.1:1. This is in agreement with a study which reported non-fatal RTI requiring admission for ≤7 were twice in male than in females [3]. Few studies have reported further higher male-to-female ratio of 4:1 [13] and up to 9:1 [14]. This is because the males outnumber the females in the studied samples. The other cause for the male abundance in RTI is that only males were allowed to drive the car in Saudi Arabia at the time of the survey, but recently females were also allowed to drive cars in KSA. One-fourth of those who involved RTAs were children. This also may explain the high rate of RTAs in this area because children drive cars illegally, before acquiring a driving license. The current number was higher compared to other studies which reported less percentage (20%) of injured children [14]. One of the limitations of the current study is that the study team did not ask about the driver of the car during RTA. The study demonstrated that the most common cause of RTI to be high speed (44.5%). This agrees with other studies (43.1%) [3] and (29%) [9]. The second most common cause of RTA in the study group was foggy weather (23.64%) which causes poor visibility was found rarely reported as a causative factor for RTA in KSA. There is a similar study conducted in Florida state in USA reporting fog/smoke-related crashes to be ranking number three among causative factors for RTI [4]. The most common weather parameter that has been considered in the literature is precipitation (rainfall, rainfall intensity, and snowfall). The foggy weather is about 3–4 months per year. This foggy weather occurs during the winter season and is associated with rainfall. The third cause (16.36%) of RTI in our study was due to the usage of the mobile phone during driving. The present study participants were much more involved in crashes due to the phone usage during driving compared with other factors, in which the involvement was only 1% [15]. The outcome of RTI in our study participants was fatal in about 6.36% and non-fatal in 93.64%. The pattern of trauma was soft tissue injury (32.73%) and fractures (23.64%). Another study reported RTI affecting soft tissue and fractures were (71.9%) and (11.6%), respectively [15]. The difference in this study may be due to the population characteristics of the latter study which includes injured subjects not only from car accidents but also from motorcycles and pedestrians. The present study includes only subjects who sustained RTI due to the car accidents. The most common site of injury was trauma affecting upper limbs (37.27%) followed by an injury to the head and neck (26.36%) and least injured part was found to be the lower limb (12.73%). Our study was not in agreement with other studies in which the lower limb was the most injured part of the body [13,16]. The patients who sustained trauma in multiple sites of the body were about 23.6%. A study showed the injury to upper limbs, head/neck, and multiples as following: 22.1%, 41.1%, and 34.4% [15], respectively. Other studies from Al Qassim and Abha showed that the most commonly injured part was the head and neck during the selected spectrum of years [3,17]. In contrast, data from Riyadh and the Armed Forces Hospital Al-Aseer reported a lower number of all types, and particularly, head and neck injuries during 2001–2006. In addition, according to the 1994 review [18], the most often injured body regions were the upper and lower extremities and the head. Again the differences in the percentage of the injury site occurred for the same reason mentioned above. Nearly, 60% of the study traumatized participants did not require hospitalization and had not been admitted because of minor injury or may be due to the refusal to be admitted. One of the limitations of the current study is that there was no question about the discharge against medical advice which was common in RTA. The rest 40% were admitted to hospital for variable periods according to the severity of the injury. Among those who had been hospitalized, 80% were discharged. About 6.36% were admitted to ICU and 13% were submitted to a surgical operation. The traffic-related death in the study participants was 6.36%. The vast majority of them were males (57.14%) and (42.86%) are females. This finding was less than what was found in other studies in which the male death was reported to be 87% [19], 82% [20], and 78% [21]. The traffic death was common among children (42.86%), the age group less than 18-year old. This could be explained by illegal driving of the car by children though we have no specific question about the driver when the accident occurred. This is in contrary to what was reported previously where most of the non-fatal injuries occurred in people subjects aged between 5 and 19 years [3]. The second age group where the death rate was high in relation to RTA was among subjects aged between 18 and 30 years with a mortality rate of 28.6%. The disability associated with the trauma in these subjects happened in 6.36%. The vast majority of this disability occurred in male subjects (85.72%). This may be logical since all drivers were males and the incidence of injury was more common in them. This in agreement with a study in which the male mortality was 71.9% [22]. On the other hand, there was a study reporting an equal incidence of disability between males and females [23]. In contrast to the mortality rate which was common in those less than 18-year old, the disability was common in those between 18- and 30-year old. More than two-fifths of disability was due to a head injury and the disability resulting from traumatic spine injury occurred in more than one-fourth of the study subjects, whereas disability from upper or lower limb trauma occurred at the rate of 14.3%.

Figure 2. (A) Site of trauma (n = 110). (B) The common cause of disability (n = 7).


Conclusion

The present study concludes that at least there is one person in Al-Baha resident families who have been exposed to RTA. The majority of RTAs were non-fatal and the most number of deaths were among children and male gender and this may be associated with the socio-economic problems associated with this study population. The fog was reported as a unique second cause for RTA in the study population. The authors recommend a high degree of collaboration between concerned authorities in the area, especially during the foggy season to provide awareness among the adults and students regarding the safety of driving.


List of Abbreviations

KSA Kingdom of Saudi Arabia
RTA Road traffic accident
RTI Road traffic injury

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethical approval was granted by the ethics committee of the Faculty of Medicine via letter number: BU/FM/RCS/2018.


Author details

Yasir Elshambaty1,2, Abdulmajeed Alzahrani1, Aimun AbdulGafar1,3, Bader Alzahrani1, Waleed Shahwan1, Abdullah AlFalah1

  1. AlBaha University, Faculty of Medicine. AlBaha, Saudi Arabia.
  2. Department of Surgery, Faculty of Medicine AlBaha University, Saudi Arabia. Department of surgery, Faculty of Medicine, Bakht Alruda University, Sudan.
  3. Department of Pharmacology, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan. Department of Pharmacology, Faculty of Medicine, AlBaha University, AlBaha, Saudi Arabia.

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How to Cite this Article
Pubmed Style

Elshambaty Y, AbdulGafar A, Alzahrani A, Alzahrani B, Shahwan W, Alffalah A. An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. IJMDC. 2019; 3(8): 694-698. doi:10.24911/IJMDC.51-1550168858


Web Style

Elshambaty Y, AbdulGafar A, Alzahrani A, Alzahrani B, Shahwan W, Alffalah A. An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. http://www.ijmdc.com/?mno=31608 [Access: July 23, 2019]. doi:10.24911/IJMDC.51-1550168858


AMA (American Medical Association) Style

Elshambaty Y, AbdulGafar A, Alzahrani A, Alzahrani B, Shahwan W, Alffalah A. An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. IJMDC. 2019; 3(8): 694-698. doi:10.24911/IJMDC.51-1550168858



Vancouver/ICMJE Style

Elshambaty Y, AbdulGafar A, Alzahrani A, Alzahrani B, Shahwan W, Alffalah A. An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. IJMDC. (2019), [cited July 23, 2019]; 3(8): 694-698. doi:10.24911/IJMDC.51-1550168858



Harvard Style

Elshambaty, Y., AbdulGafar, . A., Alzahrani, . A., Alzahrani, . B., Shahwan, . W. & Alffalah, . A. (2019) An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. IJMDC, 3 (8), 694-698. doi:10.24911/IJMDC.51-1550168858



Turabian Style

Elshambaty, Yasir, Aimun AbdulGafar, Abdulmajeed Alzahrani, Badar Alzahrani, Waleed Shahwan, and Abdulallah Alffalah. 2019. An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (8), 694-698. doi:10.24911/IJMDC.51-1550168858



Chicago Style

Elshambaty, Yasir, Aimun AbdulGafar, Abdulmajeed Alzahrani, Badar Alzahrani, Waleed Shahwan, and Abdulallah Alffalah. "An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 694-698. doi:10.24911/IJMDC.51-1550168858



MLA (The Modern Language Association) Style

Elshambaty, Yasir, Aimun AbdulGafar, Abdulmajeed Alzahrani, Badar Alzahrani, Waleed Shahwan, and Abdulallah Alffalah. "An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia." International Journal of Medicine in Developing Countries 3.8 (2019), 694-698. Print. doi:10.24911/IJMDC.51-1550168858



APA (American Psychological Association) Style

Elshambaty, Y., AbdulGafar, . A., Alzahrani, . A., Alzahrani, . B., Shahwan, . W. & Alffalah, . A. (2019) An unusual cause of road traffic accident with an unusual outcome in Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (8), 694-698. doi:10.24911/IJMDC.51-1550168858