Epidemiology, Anaesthetic Management, and Outcomes of Paediatric Traumatic Injury in a Resource-Limited Urban Centre in Douala, Cameroon

Abstract

Background: Paediatric trauma is a leading cause of global childhood mortality and morbidity, with a disproportionate burden in resource-limited settings. Traumatic brain injury (TBI) is a major contributor to poor outcomes. This study aimed to describe the epidemiology, clinical characteristics, anaesthetic management, and outcomes, including post-discharge functional status, of paediatric trauma patients in a sub-Saharan African urban hospital, and to identify predictors of mortality. Methods: We conducted a 10-month prospective, single-centre observational study at the emergency department of the Douala General Hospital in Cameroon. We enrolled all consecutive patients aged <18 years presenting with acute traumatic injuries. Data on demographics, injury mechanism, prehospital care, clinical severity (Glasgow Coma Scale [GCS]), anaesthetic management, and clinical outcomes were collected. Survivors were contacted at 3 months post-discharge to assess neurological outcome using the Paediatric Cerebral Performance Category (PCPC) scale. Inferential statistical analysis using logistic regression was performed to identify predictors of in-hospital mortality. Results: A total of 29 patients were enrolled (mean age 7.5 ± 4.2 years; 65.5% male). Non-medicalized transport was common (58.6%), and 10.3% were dead on arrival. Falls (44.8%) and road traffic accidents (24.1%) were the primary mechanisms. TBI was present in most cases, classified as mild (69.0%), moderate (13.8%), or severe (13.8%). Fourteen patients required anaesthesia, with ketamine being the most common induction agent. The overall in-hospital mortality rate for admitted patients was 5.0%, with death occurring only in the severe TBI group. In multivariate analysis, a GCS score of 3–8 was the sole independent predictor of mortality (OR 18.5, 95% CI 1.9–179.1, p=0.012). At 3-month follow-up (n=18 survivors), all patients with initial mild TBI had good neurological outcomes (PCPC 1), whereas 50% of survivors from the moderate-to-severe TBI group had moderate to severe disability (PCPC 3-4). Conclusion: Paediatric trauma in this setting is characterized by a high prevalence of TBI, significant prehospital care deficits, and substantial long-term morbidity among survivors of severe injury. Severe TBI on admission is a potent predictor of mortality. These findings underscore the urgent need for developing structured prehospital EMS, implementing standardized neuroprotective trauma protocols, strengthening specialist anaesthetic capacity, and establishing rehabilitation services to improve the entire continuum of care.