Two Decades of Road Traffic Injuries in Libya: Trends in Trauma Severity and Clinical Outcomes

Abstract

Background: Road traffic injuries (RTIs) remain a major global public health problem, with the greatest impact in low- and middle-income countries. In Libya, especially the east, long-term trauma data are limited. This study compares RTI patterns and outcomes at Tobruk Medical Center over two decades. Aim: To assess changes in injury severity, ICU utilization, and clinical outcomes among RTI patients admitted from May–July in 2005 and 2024. Methods: A retrospective hospital-based comparative study reviewed all RTI admissions from May–July in 2005 and 2024. After excluding 40 incomplete records, 400 cases were analyzed. Data included demographics, admission type (ICU/ward), surgical intervention, and outcome. For ICU patients, ISS was retrospectively estimated using a simplified AIS-based method from documented injuries. Categorical variables were analyzed with chi-square tests, and multivariable logistic regression examined the association between study year and ICU admission, adjusting for age, sex, and residence. Statistical significance was set at p < 0.05, using SPSS v26. Results: Total RTI admissions decreased from 226 in 2005 to 174 in 2024. ICU admissions increased significantly from 23 (10.2%) to 69 (39.7%) (p < 0.001). In-hospital mortality remained stable (13 vs. 14 deaths; p = 0.92), while prehospital deaths declined sharply from 90 to 18. Overall mortality dropped from 5.75% to 1.14%, and recovery rates improved from 94.2% to 98.9%. Surgical intervention rates were stable (6.2% vs. 7.5%). Multivariable logistic regression confirmed that admission in 2024 was independently associated with higher odds of ICU admission (adjusted OR = 4.2, 95% CI: 2.5–7.1, p < 0.001). Conclusion: Despite fewer RTI admissions and better survival, trauma severity in Tobruk has risen sharply over the past two decades, reflected by a nearly fourfold increase in ICU admissions confirmed by multivariable analysis. Unchanged in-hospital mortality indicates ongoing gaps in advanced trauma care. Strengthening EMS, expanding critical care capacity, and creating a national trauma registry are urgently recommended.