Pediatric Trauma in Cameroon: Prevalence, Clinical Patterns, and Outcomes in Three Referral Hospitals ()
1. Introduction
Trauma is a major cause of morbidity and mortality among children worldwide and accounts for up to 40% of pediatric surgical admissions in low- and middle-income countries (LMICs) [1]. The World Health Organization estimates that 95% of all injury-related pediatric deaths occur in LMICs [2]. In sub-Saharan Africa, road traffic accidents (RTAs), falls, burns, and domestic injuries are consistently reported as the leading mechanisms of pediatric trauma [3] [4].
In LMICs, children face heightened vulnerability due to factors such as poor road infrastructure, weak enforcement of safety regulations, and inadequate referral systems. Pediatric trauma mortality in Africa is also elevated because of the absence of prehospital care, limited pediatric trauma expertise, and delayed access to definitive management [5].
Despite children constituting more than half of Cameroon’s population [6], trauma-related data remain scarce. Existing studies originate mainly from single hospitals and often focus on specific injuries [7]. Multicenter data are necessary to inform national prevention and management policies.
This study aimed to determine the prevalence, clinical presentations, and outcomes of pediatric trauma in three major referral hospitals in Cameroon.
2. Methods
We performed a retrospective cross-sectional study from January 2019 to December 2021 in three tertiary hospitals: Douala General Hospital (DGH), Laquintinie Hospital Douala (LHD), and Buea Regional Hospital (BRH). These centers provide pediatric surgical care for the Littoral and South-West regions.
All children aged 0 - 18 years admitted for trauma were included. Ophthalmologic and ENT trauma cases were excluded.
Hospital records were reviewed to extract sociodemographic characteristics, mechanism of injury, clinical presentation, complications, and outcomes. Severe head trauma was defined as GCS ≤ 8. Hemodynamic instability required hypotension/tachycardia for age. Respiratory failure was defined by SpO2 < 90% or need for oxygen support.
Data were entered into SPSS v25. Descriptive statistics were used. Mortality was stratified by injury type. Categorical variables were analyzed using the Chi-square test and p-value ≤0.05 was considered significant.
Approval was obtained from the University of Buea Faculty of Health Sciences IRB. Hospital authorities granted administrative clearance. Confidentiality was maintained.
3. Results
Of the 10,539 pediatric admissions recorded during the study period, 537 were trauma related, representing 39.8% of pediatric surgical cases and 5.1% of overall admissions (Table 1). Boys constituted 67.5% of cases (male-to-female ratio: 2:1). The most affected age group was 6 - 12 years (29.5%), followed by 1 - 5 years (27.3%).
Table 1. Sociodemographic characteristics of pediatric trauma patients (N = 537).
Variable |
Frequency |
Percentage (%) |
Male |
363 |
67.5 |
Female |
174 |
32.5 |
Neonates (0 - 28 d) |
12 |
2.2 |
Infants (1 - 12 m) |
46 |
8.6 |
1 - 5 years |
147 |
27.3 |
6 - 12 years |
158 |
29.5 |
13 - 18 years |
174 |
32.4 |
Mechanisms of injury were predominantly road traffic accidents (42.4%) and falls (31.2%). Domestic accidents accounted for 11.8%, and assaults for 6.2% (Table 2).
Table 2. Mechanisms of pediatric trauma.
Mechanism |
Frequency |
Percentage (%) |
Road traffic accidents |
228 |
42.4 |
Falls |
168 |
31.2 |
Domestic accidents |
63 |
11.8 |
Assaults |
33 |
6.2 |
Burns/other causes |
45 |
8.4 |
Traumatic lesions were mainly fractures (46.1%) and head injuries (34.5%), representing over 80% of all injuries (Figure 1).
Clinical presentations included limb pain or swelling (49.7%), wounds (28.5%), abdominal pain (20.3%), vomiting (14.9%), and loss of consciousness (9.8%). Complications on arrival occurred in 12.6% of children, primarily anemia and peritonitis (Table 3).
Lesion-specific findings (Table 4):
Fractures: most common among school-aged children; mean hospital stay 10.4 days; mortality 9.1%.
Head injuries: highest mortality (54.5%), especially when severe (GCS ≤ 8).
Burns: predominantly in younger children; mortality 36.4%.
Soft tissue injuries: frequent but with zero recorded mortality.
Figure 1. Distribution of pediatric traumatic lesions (N = 534).
Table 3. Clinical presentations and complications.
Presentation/Complication |
Frequency |
Percentage (%) |
Limb pain/swelling |
267 |
49.7 |
Wounds |
153 |
28.5 |
Abdominal pain |
109 |
20.3 |
Vomiting |
80 |
14.9 |
Loss of consciousness |
53 |
9.8 |
Complications on arrival |
68 |
12.6 |
Table 4. Most frequent types of traumatic lesions among pediatric patients in three Cameroonian hospitals.
Type of Lesion |
Frequency (n, %) |
Most Affected Age Group |
Mean Length of Stay (days) |
Case Mortality (%) |
Main Clinical
Features/Mechanism |
Fractures |
246 (46.1%) |
6 - 12 years |
10.4 |
9.1% |
Road traffic accidents, falls; limb pain, deformity |
Head injuries |
184 (34.5%) |
12 - 18 years |
8.6 |
54.5% |
Loss of consciousness, scalp wounds, seizures |
Soft tissue injuries |
99 (18.5%) |
12 - 18 years |
7.0 |
0% |
Lacerations, swelling, infection risk |
Burns |
47 (8.8%) |
28 days - 2 years |
11.1 |
36.4% |
Flame/scald injuries, fluid loss, pain |
Blunt abdominal trauma |
33 (6.2%) |
6 - 12 years |
13.3 |
0% |
Abdominal tenderness, distension |
Chest trauma (blunt) |
8 (1.5%) |
6 - 12 years |
6.1 |
9.1% |
Chest pain, dyspnea, respiratory distress |
Penetrating chest injuries |
6 (1.1%) |
12 - 18 years |
8.2 |
0% |
Open chest wound, pneumothorax |
Dislocations |
13 (2.4%) |
12 - 18 years |
8.0 |
0% |
Joint deformity, loss of function |
Others |
17 (3.2%) |
12 - 18 years |
14.5 |
0% |
Mixed or unspecified trauma |
Postoperative complications occurred in 5.7% of managed cases. The most frequent were surgical site infection (37.3%), sepsis (16.2%), and anemia (13.6%) (Table 5). Hypovolemic shock and respiratory distress were less common but clinically significant. Delayed presentation and delayed surgical intervention were strongly associated with complications.
Table 5. Common postoperative complications after management of trauma lesions.
Type of Lesion |
Frequency (n) |
Percentage (%) |
Principal Trauma Lesions Involved |
Clinical Consequences/Remarks |
Surgical site infection (SSI) |
22 |
37.3% |
Fractures, burns, soft-tissue injuries |
Delayed wound healing, prolonged hospital stay |
Sepsis |
12 |
16.2% |
Burns, multiple trauma, infected wounds |
Systemic infection, contributed to mortality |
Anemia |
8 |
13.6% |
Burns, fractures, postoperative bleeding |
Required transfusion in most cases |
Hypovolemic shock |
4 |
6.8% |
Severe burns, abdominal or chest trauma |
Fluid/blood loss requiring resuscitation |
Wound dehiscence |
5 |
8.0% |
Soft-tissue injuries, fractures |
Delayed closure, increased infection risk |
Respiratory distress/pneumonia |
3 |
5.0% |
Chest trauma, head injuries |
Prolonged oxygen therapy, ICU admission |
Others (minor) |
6 |
9.0% |
Various trauma lesions |
Fever, delayed mobilization, electrolyte imbalance |
Outcomes (Table 6):
91.5% of children were discharged after treatment.
Mortality was 5.2%.
Severe head injuries (54.5%) and burns (36.4%) accounted for most deaths.
A small proportion left against medical advice (3.3%) or were referred for specialized care (1.1%).
Table 6. Outcomes of pediatric trauma patients.
Outcome |
Frequency |
Percentage (%) |
Discharged/survived |
491 |
91.5 |
Died |
28 |
5.2 |
Left against medical advice |
18 |
3.3 |
Referred to higher center |
6 |
1.1 |
4. Discussion
4.1. Magnitude of Pediatric Trauma
This study reaffirms that trauma accounts for a substantial proportion of pediatric surgical admissions in Cameroon. The predominance of males and school-aged children aligns with regional findings [8]-[14] and likely reflects increased exposure to roadways, unsupervised activities, and risk-taking behaviors.
The presence of complications on arrival in 12.6% of cases highlights shortcomings in prehospital care. Delayed recognition of injuries, lack of ambulance services, unsafe modes of transport, and limited first-aid knowledge likely contributed to these early complications.
4.2. Mechanisms of Injury
RTAs were the leading cause of pediatric trauma. Contributing factors include rapid urbanization, inadequate pedestrian walkways, poor road conditions, absence of child restraint regulations, and weak enforcement of traffic laws. These findings mirror those reported in other African settings [9] [15] [16].
4.3. Injury Patterns
Fractures and head injuries comprised the largest proportion of trauma lesions, consistent with patterns observed across LMICs [17]. Severe head injuries were associated with high mortality due to limited neurosurgical capacity, late presentation, and insufficient ICU facilities [18].
4.4. Mortality and Determinants of Outcome
The overall mortality of 5.2% in our study parallels earlier reports from pediatric surgery units in Africa (4% - 10%) [8] [19]. However, the case-specific mortality of 54.5% among severe head injuries underscores the gap in trauma critical care capacity.
The high fatality among burn victims (36.4%) further highlights the lack of burn units, fluid resuscitation expertise, and early excision protocols in Cameroon’s hospitals [20]. These patterns reflect both the mechanisms of injury and limited availability of specialized trauma care, especially neurosurgical support and burn units.
4.5. Postoperative Complications
The most frequent postoperative complications were surgical site infections (37.3%) and sepsis (16.2%). These are preventable through aseptic surgical techniques, antibiotic prophylaxis, and improved postoperative monitoring. Strengthening perioperative infection control, blood transfusion services, and nutritional support are key to reducing these outcomes.
4.6. Preventive Strategies
To reduce pediatric trauma, actionable preventive measures include:
Road safety enforcement: speed limits, helmet use, pedestrian crossings, speed bumps.
Child restraint laws: enforcement and subsidies for child car seats.
Community-based prevention: first-aid training, domestic safety education, school road safety programs.
Trauma system strengthening: prehospital care development, referral network coordination, and training in pediatric trauma management.
5. Study Strengths and Limitations
5.1. Strengths
5.2. Limitations
Retrospective nature leading to incomplete records.
Lack of long-term follow-up on functional outcomes.
Absence of prehospital mortality data.
6. Conclusion
Pediatric trauma is a leading cause of morbidity and mortality in Cameroon, dominated by road traffic accidents and falls. Boys and school-aged children are most at risk. Mortality remains high, particularly in severe head injuries. Preventive measures, better referral pathways, and improved trauma care capacity are urgently needed.