Doing More with Less: A District Hospital’s Early Experience with a Trauma System Implementation

Nizarulikram, Muhammad Jalaluddin; Shashi Kumar, Nuhes Seelan; Lim, Jeanne Jing Wen; Mohd Azahar, Mohd Syakir; Liew, Sarah Ileen

doi:10.30491/tm.2026.604068.2001

Doing More with Less: A District Hospital’s Early Experience with a Trauma System Implementation

Document Type : Original Article

Authors

Muhammad Jalaluddin Nizarulikram ¹

Nuhes Seelan Shashi Kumar ¹

Jeanne Jing Wen Lim ²

Mohd Syakir Mohd Azahar ²

Sarah Ileen Liew ²

¹ Department of Surgery, Hospital Segamat, Johor, Malaysia

² Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

10.30491/tm.2026.604068.2001

Abstract

Introduction: Segamat Hospital (SH) faces challenges in providing optimal trauma care due to multiple factors. Information on Malaysian district hospital trauma outcomes is limited. This study aimed to ascertain our trauma outcomes as well as to determine if a trauma system is a feasible means to reduce trauma mortality in the context of a resource-limited setting.
Method: SH began implementing an organized trauma system as well as a massive transfusion protocol (MTP) on 1st January 2025. This cross-sectional retrospective study included trauma cases requiring general surgical intervention from January 2021 to December 2025, whilst patients with isolated traumatic brain injuries, isolated long bone injuries, isolated burn injuries, and pediatric patients were excluded. Data on demographics, mechanism of injury, severity of injury, and outcomes were collected and analyzed. Comparison of patient outcomes pre- and post-trauma system implementation was performed.
Result: A total of 112 patients (mean age 34.5 years; 76.8% male) were included. Blunt trauma from motor vehicle accidents accounted for most of the injuries. Overall mortality and complication rates were 14.3% and 38.4%, respectively. The most common complication was acute kidney injury. Irreversible hemorrhagic shock and severe brain injuries accounted for the majority of the mortalities. Pre- and post-implementation of trauma system cohorts were similar in injury characteristics. Time to the operating room was significantly shorter after trauma system implementation (p=0.001). Although overall mortality rate remained above 10% post trauma system implementation, no deaths were attributed to massive hemorrhage, suggesting that hemorrhage-related mortality may have been reduced.
Conclusion: Our early findings suggest that an organized trauma system is not only feasible despite resource limitations, but that a context-specific trauma system may prevent deaths from massive hemorrhage without contributing to futile care. Further research is necessary to confirm our preliminary findings and explore the scalability and cost equity of trauma systems in district hospitals.

Keywords

Trauma surgery

Emergency general surgery

Surgical Trauma Care

Rural Health Services

Subjects