Road traffic injury (RTI) is the third leading cause of death in Saudi Arabia. Using a mobile phone when driving is associated with distracted driving, which may result in RTIs. Because of limited empirical data, we investigated the association between mobile phone use and RTI in injured patients and community controls in Riyadh. Cases were patients admitted to King Abdulaziz Medical City (KAMC) between October 2016 and March 2018 due to RTIs. During admission, mobile phone use at the time of the accident was investigated. The controls were drivers observed at various locations citywide. A logistic regression model was constructed to estimate the association between mobile phone use while driving and sustaining RTIs. We included 318 cases and 1700 controls. For the cases, using a mobile phone was associated with higher severity and prevalence of disability. In addition, using a mobile phone while driving is associated with 44% higher odds of incurring a severe RTI (p = 0.04). Mobile phone use while driving is prevalent in Riyadh and pose a significant threat of disability. In addition, the low prevalence of seatbelt use is alarming and requires significant improvement. Prevention programs may use these findings to educate the public and policymakers and to advocate for increased visibility of enforcement to reduce RTIs and improve population health.

Computerized Physician Order Entry (CPOE) analgesia-sedation protocols may improve sedation practice and patients’ outcomes. We aimed to evaluate the impact of the introduction of CPOE protocol. This was a prospective, observational cohort study of adult patients receiving mechanical ventilation, requiring intravenous infusion of analgesics and/or sedatives, and expected to stay in the intensive care unit (ICU) ≥24 h. As a quality improvement project, the study had three phases: phase 1, no protocol, July 1st to September 30th, 2010; phase 2, post implementation of CPOE protocol, October 1st to December 31st, 2010; and phase 3, revised (age, kidney and liver function adjusted) CPOE protocol, August 1st to October 31st, 2011. Multivariate analyses were performed to determine the independent predictors of mortality. Two hundred seventy nine patients were included (no protocol = 91, CPOE protocol = 97, revised CPOE protocol = 91). Implementation of CPOE protocol was associated with increase of the average daily dose of fentanyl (3720 ± 3286 vs. 2647 ± 2212 mcg/day; p = 0.009) and decrease of hospital length of stay (40 ± 37 vs. 63 ± 85 days, p = 0.02). The revised CPOE protocol was associated with, compared to the CPOE protocol, a decrease of the average daily dose of fentanyl (2208 ± 2115 vs. 3720 ± 3286 mcg/day, p = 0.0002) and lorazepam (0 ± 0 vs. 0.06 ± 0.26 mg/day, p = 0.04), sedation-related complications during ICU stay (3.3 % vs. 29.9 %, p 70 years or with severe kidney or liver impairment. Both the original CPOE protocol and the revised CPOE protocol were not independent predictors of ICU (adjusted odds ratio [aOR] = 1.85, confidence interval [CI] = 0.90–3.78; p = 0.09; aOR = 0.70, CI = 0.32–1.53, p = 0.37; respectively) or hospital mortality (aOR = 1.12, CI = 0.57–2.21, p = 0.74; aOR = 0.80, CI = 0.40–1.59, p = 0.52; respectively). The implementation of a CPOE analgesia-sedation protocol was not associated with improved sedation practices or patients’ outcome but with unpredicted increases of an analgesic dose. However, the revised CPOE protocol (age, kidney and liver function adjusted) was associated with improved sedation practices. This study highlights the importance of carefully evaluating the impact of changes in practice to detect unanticipated outcomes.

An injury to the pericardium or the great vessels is considered a true medical emergency, with a poor survival rate. The early identification and immediate response from all the medical services play a significant role in the management of this type of injury. In this case report, we report a young male patient brought to the emergency room (ER) after sustaining two stab wounds to the chest. We present the successful management of the patient from admission to the ER until discharge a few days later, after a successful surgical intervention for a penetrating cardiac injury.

Background: The acute care surgery (ACS) model employs a 24/7 multidisciplinary team—surgeons, nurses, and residents—supported by an electronic consultation system to optimize emergency The acute care surgery (ACS) model provides 24/7 multidisciplinary management of emergency surgical patients. This study aimed to describe the demographic and clinical characteristics of patients admitted from the emergency department (ED) under general surgery, identify the most common presenting complaints and operative procedures, and determine which general surgery subspecialties were most frequently consulted at King Abdulaziz Medical City (KAMC). Methods: We conducted a retrospective study at KAMC, Riyadh (MNGHA), from September 2022 to November 2023. A total of 384 ED patients admitted under general surgery were included. Data were extracted from the BestCare electronic medical record and analyzed for demographics, presenting complaints, operative procedures, and subspecialty consultations. Results: Of 384 patients, 204 (53.1%) were male and 180 (46.9%) were female. The largest age group was 30–45 years (n = 112, 29.2%), followed by <30 years (n = 98, 25.5%). Leading presenting complaints were abdominal pain (n = 243, 63.3%), fever with nausea/vomiting (n = 68, 17.7%), and rectal pain/bleeding (n = 44, 11.5%). Laparoscopic cholecystectomy was the most common procedure (n = 123, 32.0%), followed by laparoscopic appendectomy (n = 57, 14.8%). ACS received most consultations (n = 231, 61.8%), with additional referrals to colorectal surgery (n = 86, 23.0%) and upper gastrointestinal surgery (n = 40, 10.7%). Nearly all consult requests originated in the ED (n = 355, 98.9%). Conclusions: Abdominal pain was the predominant ED complaint prompting surgical referral, and laparoscopic cholecystectomy and appendectomy were the most frequently performed procedures. ACS was the primary subspecialty consulted, underscoring its central role in emergency surgical care at KAMC.

Background/Objectives: Mesh repair reduces hernia recurrence compared with suture repair, but permanent synthetic meshes are associated with chronic foreign-body complications. Biosynthetic poly-4-hydroxybutyrate mesh (Phasix™) provides temporary reinforcement with gradual resorption; however, short-term real-world outcomes across different hernia types remain limited. This study evaluated short-term outcomes after Phasix™ hernia repair and identified factors associated with baseline recurrent hernia at presentation. Methods: This retrospective cohort included patients ≥ 16 years who underwent open or laparoscopic hernia repair with Phasix™ at King Abdulaziz Medical City (2020–2023). Patients receiving other mesh types were excluded. Demographic, operative, and postoperative data were analyzed. Multivariable logistic regression identified factors associated with baseline recurrent hernia. Results: Among the 228 patients (51.8% female; mean age 55 years), hernia types were incisional (36.0%), paraumbilical (26.3%), and inguinal (24.6%). Early complications were uncommon: seroma in 2.2% and surgical site infection in 1.8% at 1 month. One-year recurrence occurred in 1.3% (3/228). Female sex, prior incisional hernia repair, previous mesh removal, and open repair independently predicted baseline recurrent hernia, while laparoscopic repair was protective. Conclusions: Phasix™ repair demonstrated low short-term complication rates and rare 1-year recurrence across ventral and inguinal hernias. Short-term outcomes were driven mainly by patient and procedural factors rather than mesh-specific effects.