Hospital-treated pediatric trauma in Saudi Arabia: a systematic review with limited prehospital-linked evidence on injury mechanisms, anatomical patterns, severity, and clinical outcomes

Abstract Background Pediatric trauma is a major source of preventable morbidity, mortality, disability, and long-term health loss. Saudi evidence is distributed across emergency departments, trauma registries, intensive care, burn services, anatomical specialty cohorts, and emergency medical services. This review primarily synthesized hospital-treated pediatric trauma evidence and separately characterized the much smaller prehospital-linked evidence stream. Methods The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Searches covered seven databases, Google Scholar supplementary screening, reference lists, and the Saudi Digital Library from inception to 29 June 2026. Two reviewers independently completed screening, extraction, and design-specific Joanna Briggs Institute risk-of-bias assessment, with adjudication by a third reviewer. The review was not prospectively registered. Pooling was permitted only for outcomes with comparable source populations, definitions, and denominator units. Results Eighty-three unique imported records were identified; 14 duplicates were removed, 69 records were screened, 38 full-text reports were assessed, and 32 Saudi clinical reports were included after a citation-level corpus audit. Six full-text reports were excluded for non-Saudi setting, non-separable adult data, absent auditable denominator, drowning-only scope, or a non-clinical unidentified survey entry. Of the 32 included reports, one report (3.1%) was a direct national emergency medical services dataset; the remaining evidence was hospital-, registry-, or specialty-based, with selected hospital cohorts contributing limited transport-related variables rather than stand-alone prehospital pathway evaluation. Road traffic injury was prominent in severe-care and registry populations, while falls and burns were important in general emergency and home-injury cohorts. Broad meta-analysis was rejected because mechanisms, mortality, length of stay, sex, and severity were reported using non-exchangeable source populations and denominator units. Conclusions Saudi pediatric trauma evidence supports setting-stratified clinical and public-health conclusions but not indiscriminate pooling. A national pediatric trauma minimum dataset, governed jointly by public-health authorities and the pediatric trauma clinical enterprise, should standardize age bands, mechanism definitions, physiology, severity, prehospital care, procedures, disability, rehabilitation, and follow-up. A phased implementation over approximately three to four years is feasible, but a formal national business case is required before assigning a monetary cost. Clinical trial registration Not applicable.