Injuries encompass a wide range of physical assaults, whether intentional or accidental. According to the World Health Organization (WHO), they are a major cause of death and disability worldwide, resulting in approximately 4.4 million deaths annually and accounting for 12% of the global burden of disease.1,2 Their impact is particularly high in low- and middle-income countries (LMICs), where medical infrastructure is often inadequate.
In Africa, numerous studies have highlighted that road traffic accidents (RTAs) are the main cause of injuries, mainly affecting young men.2–8
Pre-hospital care remains a weak link in several countries on the continent, due to the absence or underdevelopment of emergency services such as SAMU or SMUR.2,6 This situation is exacerbated by rapid urbanization and increasing motorization, which mechanically increase the risk of accidents.
In the Democratic Republic of Congo (DRC), and more specifically in the city province of Kinshasa (VPK), several factors aggravate the frequency of injuries: accelerated population growth, uncontrolled increase in the vehicle fleet, non-compliance with highway codes, deterioration of road infrastructure, urban insecurity (Kuluna phenomenon), proliferation of unregulated construction sites, poverty, unemployment and socio-economic stress.
Traumatic injuries in this context are of varying severity. They can lead to death or leave serious physical and psychological after-effects, with lasting social, professional and economic repercussions. Despite their frequency and impact in VPK, few studies have systematically explored the causes, clinical typology and management modalities of trauma.6,7,9,10
Thus, this study aims to characterize trauma in a peace context in the VPK, by analyzing their epidemiological and clinical dimensions and the challenges of pre-hospital and hospital care . The results will provide food for thought for better prevention and a more effective medical response to trauma in the Congolese capital.
METHODS
Framework of the study
This observational case series study was carried out at the Department of Surgery of the University Clinics of Kinshasa (CUK), a tertiary-level hospital structure in the DRC, specializing in the management of serious pathologies, particularly trauma.
Type, period and population of the study
The study took place over 14 months, from September 2023 to October 2024. It focused on patients admitted for traumatic injuries in emergency, consultation, or referral. Patients who consented to participate and whose medical records were usable were included. Those admitted outside the study period or who refused to participate were excluded.
Size and sampling technique
The sampling was non-probability and exhaustive, including all cases meeting the inclusion criteria. This choice was explained by the need to collect all available data in a resource-limited hospital setting. The final sample size was 337 patients, which accurately reflects the trauma burden in this reference center.
Variables studied
The data concerned sociodemographic characteristics (age, sex, profession), clinical characteristics (type and location of injuries), circumstances of the trauma, treatment times, therapeutic modalities (pre- and per-hospital), as well as complications.
Data collection and analysis
Data were collected via a KoboCollect electronic form and extracted from medical records, operating room registers, and emergency reports. After exporting to Excel, they were analyzed using SPSS 29.0. Qualitative variables were expressed as frequencies, and quantitative variables as medians and interquartile ranges, according to their distribution.
Ethical considerations
Approval from the University of Kinshasa Ethics Committee was obtained prior to the start of the study, ensuring compliance with ethical research principles. Informed consent was obtained from patients or their legal representatives after full information on the study objectives and procedures. Data were processed anonymously, and their confidentiality was strictly maintained to respect the privacy and dignity of participants.
RESULTS
Sociodemographic characteristics of patients
Of 337 patients with traumatic injuries, 70.6% were men, more than half of these patients were under 29 years old and the most affected age group was 15-30 years with 46.9%, 45.7% were self-employed and 71.2% had at least a secondary education level.
Clinical parameters of patients
Road accidents are the main cause of injuries (60.5%), followed by assaults (21.7%).
The majority of patients (88.4%) were admitted within one hour of the accident. However, the time between diagnosis and treatment shows a high proportion (76.3%) of patients treated within 1 to 5 hours.
Physical examination of trauma patients reveals a variety of physical signs, some more common than others. These signs vary depending on the injuries and their locations on the various systems. Swelling, wounds, deformities, and tenderness on palpation are the most commonly observed signs, present in nearly 50% of patients. Limb shortening and abnormal mobility are less common. Motor and sensory deficits are relatively rare, affecting less than 10% of patients.
Analysis of imaging examinations performed on trauma patients reveals variable use depending on the type of suspected injury. Abdominal examinations, such as ultrasound and CT scan, as well as chest X-rays, are relatively uncommon, performed in less than 10% of patients. In contrast, cranioencephalic CT scans and X-rays of the affected limb segment are the most frequently performed examinations.
Limb injuries accounted for the majority of cases at 33.2 % , with fractures being predominant. Cranioencephalic and maxillofacial injuries constituted a significant group, with various injuries such as COEC (3.9%) and subdural hematomas (SDH, 2.4%). Abdominal injuries , including splenic and hepatic ruptures, and parietal wounds accounted for 2.1 % on ultrasound and 0.9% on CT scan, respectively. Thoracic injuries were overall rare, with each individual type constituting less than 1% .
This table demonstrates that the majority of polytraumas observed involve a combination of craniocerebral trauma (TCE) and osteoarticular (OART), representing 45% of cases. Other combinations involving maxillofacial (MF), abdominal (ABD) or vertebro-medullary (TVM) are less frequent, each varying between 3% and 8% . Finally, 26% of cases are classified as “other”, highlighting a diversity of the lesion association.
Pre- and per-hospital care and progress
Analysis of patient care reveals a variety of surgical procedures, ranging from major to minor surgical procedures depending on the injuries. Major surgical procedures such as emergency laparotomy and amputation were relatively rare, performed in 5% and 2.7% of patients respectively. Osteosynthesis was performed in 39 patients (11.6%). Furthermore, plaster cast immobilization and surgical debridement, although minor, were the most frequently performed procedures in 32.3% and 35.6% of cases. Neurosurgical procedures were uncommon. No victim received care at the scene of the tragedy.
More than half of the patients had not undergone surgery (51.6%). Patients who underwent surgery represented 48.4% of the cases, the majority of whom had simple postoperative outcomes (40.7%). However, the minority had developed complications, including death in (3.3%).
DISCUSSION
Key results
The study reveals several important points regarding traumatic injuries received at CUKs. Road traffic accidents are the main cause of these injuries, followed by assault. Pre-hospital care is nonexistent. The most commonly used imaging tests are brain CT and limb X-rays, suggesting a high frequency of head injuries and osteoarticular injuries. In-hospital care varies depending on the severity of the injuries, ranging from plaster cast immobilization to major surgical interventions. However, more than half of the patients did not require surgical intervention. Post-operative outcomes are generally favorable, but some complications, sometimes serious, including deaths, have been reported. In summary, this study highlights the importance of road traffic accidents as a cause of injuries in Kinshasa, as well as the challenges related to the care of the injured, both before hospitalization and in the hospital.
Sociodemographic data
Patients aged 15 to 30 years were the most represented, with a median age of 20 years, reflecting increased exposure of this age group to trauma-generating activities. This trend is consistent with the literature, where young adults are considered an at-risk population due to their high mobility and involvement in informal sectors.2,3,6,9,11 Males predominated (70.6%), which is explained by greater participation of men in outdoor and potentially dangerous activities. Other studies have observed the same dynamics.2–4,6,9,11
On the professional level, the high representation of self-employed workers (45.7%) suggests that this category, often exposed to urban risks without social protection, is particularly vulnerable. This distribution differs from that reported by Konan K et al. (16%), which could be explained by differences in context and methodology.12 The majority of patients had a secondary education level, reflecting a young population in a situation of resourcefulness.
Clinical data
AVPs emerged as the leading cause of trauma, followed by assaults, a result that aligns with several African studies.2–5,9,11 The predominance of AVPs may be linked to uncontrolled urbanization, the growth of the motorcycle taxi fleet, poor road conditions, and non-compliance with traffic laws. The WHO reported an increase in accident-related deaths in low- and middle-income countries in 2019.1,13
The assaults (21.7%) highlight persistent urban insecurity. Odimba E. also reported this cause as significant in his study,2 highlighting the need for community security approaches. The majority of patients were admitted within one hour of the trauma, a shorter time than those reported by Nsiala and Obame (6.5 to 24 h),9,14 probably due to differences in the organization of hospital services.
Osteoarticular lesions, particularly of the limbs, dominated the clinical picture, followed by cranial lesions. This distribution is consistent with the nature of AVP, responsible for high-impact trauma.2,3,6,11 The most commonly used imaging was limb radiography, followed by cranial CT, reflecting the priority diagnostic needs in this context. Combined lesions (skull and bones) were common, as also reported by Obame.14
Support and development
No patient received pre-hospital care, a deficit reported in several African studies.2,3,6 This gap is explained by the absence of emergency systems such as SAMU (Urgent Medical Aid Service) or SMUR (Mobile Emergency and Resuscitation Service), which are often non-existent or underdeveloped due to a lack of funding, adequate training and appropriate public policies.
In hospital settings, care varied depending on the injuries, ranging from minor care (debridement, immobilization) to major surgical procedures such as osteosynthesis, laparotomy or hematoma evacuation. These data are close to those reported by Krah KL et al., who highlight the diversity of procedures depending on severity.15
The postoperative outcome was generally positive: more than half of the patients did not have any postoperative complications, and 40% had a favorable outcome. Complications remained rare (7.4%), the most frequent being deaths (3.3%), followed by surgical site infections and anemia. The differences observed with other series1,16,17 can be explained by the quality of care, the protocols used, the level of resources available, or even the characteristics of the patients (age, comorbidities, severity of injuries). These factors directly influence the occurrence of complications and the functional or vital prognosis.
Strengths and limitations of the study
This study, based on real-world data from a high-volume referral hospital, highlights the clinical, epidemiological, and organizational characteristics of trauma in Kinshasa. It offers useful benchmarks for prevention and improvement of care. However, its single-center design, lack of long-term follow-up, and limited analysis of socioeconomic factors limit its generalizability. Future multicenter research, including prehospital and post-trauma care trajectories, is needed to consolidate these findings and guide public health policies.
CONCLUSIONS
This study reveals the high frequency of trauma in CUKs, mainly linked to road accidents and assaults, and highlights the lack of structured pre-hospital care. It recommends strengthening medical ambulance services, training first aid personnel, and modernizing surgical equipment. The establishment of a register to monitor the injured and the integration of socioeconomic factors into care protocols would contribute to sustainably improving the quality of care and guiding effective prevention policies in Kinshasa.
Acknowledgements
We would like to thank the authorities of the University of Kinshasa, the Faculty of Medicine and university clinics, as well as the facilitators for their support throughout the writing process.
Funding
None.
Authors’ contributions
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Vasco Kapinga: Designed the study, supervised data collection, processed and analyzed the results, interpreted the clinical and epidemiological data, wrote the master’s thesis, and prepared this article.
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Dieudonné Nsanduku: Participated in the development of the methodology, supported the statistical analysis, interpreted the contextual data and contributed to the scientific structuring of the manuscript.
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Bernard-Kennedy Nkongolo: Provided technical expertise on clinical and public health aspects, contributed to the critical analysis of the results, particularly in the discussion, and guided the final drafting.
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Nkodia Lutumba Ezéchiel, Sita Mantu Gloire: participated in data collection and provided technical assistance during extractions from hospital records.
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Veyi Tadulu Dickson: Supervised the entire research process, validated the different versions of the protocol, suggested methodological guidelines, and supervised the revision and finalization of the manuscript.
Competing interests
The authors have completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and report no relevant interests.
Corresponding Author:
Vasco Kapinga,
kapingv@gmail.com
Contact: +243821544082