A total of 2127 trauma patients were included in the study.

Sex and age

Table 1 reports the distribution of patients by age and sex. The most affected population was aged between 20 and 39 years old (p < 0.05). The sex ratio revealed a significant superiority of men (1318 against 809 women, i.e. M/F equal to 1.6). The mean age of the patients was 27.3 ± 14.2 years (range: 1 - 84 years).

Socio-professional category

Table 2 reports the distribution of patients according to socio-professional category.

Patient transport was provided mainly by non-medical vehicles in 94% of cases

Abreviations: *p < 0.05 according to the Sokal test.

(n = 2000). It was more taxis and private cars (n = 1621, or 76.5% of cases). The use of an ambulance was only required in 6% of cases (n = 127).

Among the causes of trauma, road accidents (n = 819; 38.5% of cases) ranked first. Physical attacks (brawls, fights) were 513 (24.1%). The other causes were assaults with firearms and stabbings (189, or 8.9%) and falls (580, or 27.3%). Burns accounted for 1.2% of cases (n = 26). Two groups of victims made up all the patients (Table 3): polytraumatized and monotraumatized.

Trauma-related injuries

Cranial, spinal and limb injuries (Table 4) were dominant (1479/2127, i.e. 69.5%; p < 0.05). Among these, we found mainly and in decreasing order: fractures of the limbs and/or vertebrae (442, i.e. 20.8%), contusions of the limbs

Abreviations: ^ap < 0.05 ; **p < 0.01.

(344, i.e. 16.1%), injuries due to head trauma (315, or 14.8%), wounds (108, or 5.1%), sprains and maxillofacial trauma (84 cases each, or 3.9%), dislocations (41, or 1.9%) and spinal contusions (39, or 1.8%). Cranial involvement was found in 10 patients and 9 cases of limb amputation were noted.

Regarding injuries to the thorax, abdomen and pelvis (Table 5), there were 648 (30.5%). They preferentially consisted of simple thoracic contusions (65, i.e. 3%), abdominal contusions without visceral injury (39, i.e. 1.8%), wounds of the abdominal wall (21 cases, i.e. 1%), chest wall (17, or 0.8%), fractures of the pelvis (15, or 0.7%) and ribs (13, or 0.6%).

Abdominal trauma that came after head trauma concerned 72 patients (72, or 3.4%); they were isolated or associated with other disorders. The distribution of patients according to the type of trauma and severity is recorded in Table 6.

The application of the Chi-square test revealed a significant association between

Distribution of patients according to type and severity of trauma.

the severity of the trauma and the type of trauma (χ² = 21.27; p = 0.0213).

Therapeutic aspects

Among 2127 trauma patients, 1457 of them (68.5%; p < 0.05) received medical treatment and 457 (21.4%), orthopedic treatment. Only 216 patients (10.1%) received a surgical treatment depending on the lesions.

Mortality

A total of 32 patients died during the study period. Trauma-related mortality was estimated at 0.6% within 24 hours. Deaths were mainly related to polytrauma in 92% of cases (n = 29). Mortality was correlated with the severity of Champion’s Trauma Score: it increased inversely with the index (22 patients with severe status, 7 with moderate status and 3 with minor severity).

Traumatic emergencies are the main reason for consultation in the emergency unit of the University Hospital of Brazzaville, with a frequency of 75.1% of all emergencies. In subsaharan Africa, studies by Korsaga et al. [14] in Burkina Faso in 2019, Abdou Raouf et al. [15] in 1998 in Gabon also report that traumatic urgency is the first reason for consultation with respectively 81.9% and 86.3% of cases. Our finding is similar in France where according to the Isle-de-France Regional Hospitalization Agency, traumatic emergency was the first reason for consultation in emergency unit’s admissions in 2019, with 57% of all emergencies [16].

We found in our study a male predominance (61.9% of cases), an observation which is in line with that of other authors. For example, Degas et al. in Sudan [17], Sima Zué et al. [18] in Gabon report a male predominance with 85.6% and 65.9% respectively. In the Congo, the excessive number of men driving vehicles and their involvement in most armed conflicts, brawls and other violent acts are undoubtedly explanatory factors for this trend. We also found that the population most affected by trauma is young people and adults aged 21 - 40 years old (59.9% of cases; p < 0.05), one of the most active social strata in the economic development of the country. Among these, we find in the first rank students, workers, merchants, teachers and senior state executives as well as the liberal professions. Our observations agree with those of Degas et al. [17] in Sudan where workers represent 43.3% of the cases followed by pupils and students (23.3%). Laurent [19] in France also reported a predominance of schoolchildren, workers, transport professionals and brokers in the occurrence of head and bone and joint injuries.

In our series, road accidents predominated with 38.5% of cases; falls, physical assaults and assaults with firearms and stabbings followed with 27.2%, 24.1% and 8.8% respectively. In subsaharan Africa, Moba et al. [20] in the Democratic Republic of Congo, Diakité et al. [21] in Guinea-Conakry, Korsaga et al. [14] in Burkina Faso and Degais et al. [17] in Karthoum (Sudan) had also reported a predominance of road traffic accidents. This observation was found in Algeria [22], Brazil [23] and in several Western countries [24] [25]. In China, studies by Zhang et al. [26], from the Chinese Ministry of Public Security [27] report respective rates of trauma per road traffic accident of 88.6% and 87%. In western India, Gandon et al. [28] found in a study carried out in 1994 that road accidents accounted for 52% of injuries, against 20% for intentional blows and injuries and 20% for other etiologies.

In addition, it appears from the study by Moba et al. [20] in relation to the injury assessment that fractures predominated (26% of cases against 20.8% in our series), followed by various wounds (23.3%). They were preferentially localized to the limbs and the belt (55.4%), the head and the neck (31%), to the trunk (13.6%). The limbs and the belt accounted for more than half of cases (55.4%). Polytraumas were much rarer compared to isolated lesions (8% versus 92%). However, in our series, their rate is scarced with a frequency evaluated at 27.4%. The factors who explained the high frequency of injuries by road accident in Congo are multiple: excessive speed of vehicles; heterogeneity of road network users (drivers of motorized vehicles, pedestrians, passengers); non-compliance with the Highway Code by drivers and pedestrians, and the passages reserved for the latter; excessive overloading of public transport vehicles for the sole purpose of gain; long working hours of drivers and consequent loss of vigilance; movement of second-hand vehicles not subject to the usual technical inspection. In addition, the human factor also appears to be an important factor of road accidents, as indicated by a road safety report in 2005, which established the responsibility for fatigue, drowsiness, drunkenness and drug use by drivers.

The young age of victims of road traffic accidents, between 20 and 39 years in our study, is in line with other studies [29] [30] [31]. The high risk of road accidents among our subjects could be explained by their greater mobility and their activities of a diverse nature that characterize African youth in general, Congolese in particular in search of survival. In addition, the birth rate is high in Congo and life expectancy is around 51 years [32]; the young population is therefore the largest. The high frequency of road traffic injuries in this age group, the most active and productive, thus constitutes a serious economic loss for the community.

With regard to injuries caused by intentional blows and injuries and assaults (by firearms and bladed weapons), they are attributable to delinquency in all forms, to the increased poverty of households, the depravity of morals and the loss of the habits and customs of the Congo’s peoples (Kongo, Mbosi, Téké, Vili). As regards the first two factors mentioned, they were also found in Mexico by Moye-Elizaide et al. [33].

The falls which represent 27.2% in our series, are consecutive to falls from a height (trees, stairs), found in the majority of cases at home.

Assaults by firearms rank fourth in our series (n = 189; 8.8%). Hugenberg et al. [34] in 2007 in Nairobi (Kenya) reported over a period of 24 months, a frequency of 17.5%.

As for the mode of transport of patients to the emergency room, 94% of cases were transferred from the accident site to the hospital by land and by private individuals, without initial care, without medicalization of the transfer vehicle and without prior warning of the admissions’ unit of emergencies (corollary with congestion in the surgical emergency unit). This situation reflects an insufficiency or even absence of any first aid in the Congolese health system.

We found a significant association (p = 0.0213) between trauma severity and trauma type. Indeed, polytraumas, isolated traumas of the skull and spine were the most serious in our series. Polytraumas were 97 in number in our study, i.e. 4.6% of all traumas. Abdou Raouf et al. [15] reported trauma to the limbs and/or pelvis in 48%, the skull and face in 22% of cases, polytrauma representing a total of 10% of cases. On the other hand, Diakité et al. [21] report a predominance of skull trauma with 50% of cases. This predominance of trauma to the limbs and the skull can be explained by the high exposure of these segments and body surfaces in the mechanisms of trauma, compared to other parts of the body.

In relation to the severity of the lesions, the Champion’s Trauma Score made it possible to classify our patients into 3 groups: 1) patients who suffered from severe trauma and suffered from one or more vital distresses (Champion’s Trauma Score ≤ 10). In our series, these emergencies accounted for 13.5% of cases. There were 21 severe head injuries, 12 patients with cervical spine fractures and 2 patients with severe chest injury. Abdou Raouf et al. [15] reported 12% of cases falling under this category of emergencies. 2) Patient victims of trauma not immediately threatening the life of the injured person, but which may be the cause of subsequent death or significant sequelae (Champion’s Trauma Score between 11 and 13). In our series, 22.4% of cases were related to these emergencies compared to 27% in the study by Abdou Raouf et al. [15]. 3) Minor traumatic emergencies (with a Champion Trauma Score between 14 and 16). This was the batch of traumatology found in our study, with patients presenting with wounds, muscle contusions, sprains and simple lesions of the extremities (64.1% of cases; p < 0.05). Abdou Raouf et al. [15] also report a predominance of minor trauma, with 61% of cases.

Thirty-two patients, or 15.04%, died: 13 in the first 24 hours and 19 during their stay in intensive care. Five deaths were due to isolated head trauma. Deaths following polytrauma resulted from two associations: head trauma and abdominal contusion (n = 18); abdominal contusion and chest involvement (n = 9). The mortality proportionally linked to the Champion’s Trauma Score is suggestive of the limited resources (neurosurgeons and medical imaging), which make the management of traumatic brain injury difficult in African countries [35] [36].