Injury patterns in road traffic victims comparing road user categories: Analysis of 811 consecutive cases in the emergency department of a level I institution in a low-income country

Background: More than a million people die every day on world's roads and according to current estimates traffic related injuries will become the 5th highest killer in the world by 2030. Low and middle-income countries carry over 90% of this burden with substantial socio-economic consequences. Policies to reduce this burden are currently centered on preventive measures and the care of the injured is still neglected. This study aims at describing the crash characteristics and pattern of injuries in an urban area of a middle-income country with particular emphasis on the differential analysis of various road user categories. Methods: in this prospective cohort analysis conducted over a period of 5 months in the casualty department of the largest hospital in the city of Douala in Cameroon, all patients admitted after sustaining a traffic related injury were analyzed for crash characteristics, pattern and severity of injury and final outcome after a maximum follow-up period of 1 week. The analysis compared various user categories for different variables. Results: a total of 811 cases could be analyzed. These included 586 (72.2%) males for a sex-ratio of 2.6/1. Motorized two-wheelers and pedestrians represented overall over 80% of all victims and the most frequent collision involved a motorcycle and a tourist car. Over 95% of victims did not use a protective device. Most patients sustained external soft tissue lesions frequently involving the limbs and face. A total of 280 patients (34.52%) sustained a limb fracture. The most frequently fractured bones were the tibia, fibula and femur. Most injury cases were minor or moderate and collision between a motorcycle and a truck resulted in a significantly more severe injury. Motorized two-wheelers and pedestrian were significantly more exposed to external injuries while car occupants were more exposed to chest and spine injuries. Conclusion: crash characteristics in Douala are greatly influenced by the popularization of motorized two-wheelers who are exposed to collision with tourist cars. Victims mostly tend to develop external lesions resulting in minor injuries. However, there is need to emphasize on the need to associate to current preventive measures an appropriate policy of management of the injured. Keywords: Road traffic victims, Pattern of injury, Emergency department, Laquintinie hospital, Road user category, Low-income country, Outcom