Road traffic crash mortality in Southwest Cameroon: a multicenter hospital study

Background Road traffic crashes (RTCs) are a leading cause of injury-related mortality in Africa, where weak pre-hospital and trauma care systems contribute to preventable deaths. In Cameroon, RTCs account for a substantial proportion of trauma admissions, yet hospital-based mortality trends and determinants remain poorly described. Methods We conducted a five-year retrospective multicentre observational study of patients admitted following road traffic crashes to three regional referral hospitals in Southwest Cameroon between January 2020 and December 2024. Hospital admission registers and individual patient records were reviewed. All in-hospital deaths were included; while a representative sample of survivors was selected using stratified random sampling by study centre. Data were extracted using a structured tool and analysed descriptively. Trends in admissions and mortality were examined, centre-specific in-hospital mortality rates calculated, and factors independently associated with mortality identified using multivariable regression analysis. Results : A total of 3266 RTC admissions were recorded during the study period, with 153 in-hospital deaths. Overall in-hospital mortality was 4.7%, with significant variation across centres (p < 0.001). Annual deaths increased by approximately 22% over the study period. On multivariable analysis, delayed presentation of 30–60 min (aRR: 2.0), interurban road crashes (aRR: 1.5), severe (aRR: 8.6) and critical injuries (aRR: 9.0), presence of comorbidities (aRR: 1.7), and traumatic head or spinal injuries (aRR: 2.3) were independently associated with increased mortality. Discussion In-hospital mortality following road traffic crashes in Southwest Cameroon is high and increasing, with significant variation across referral centres. Mortality is driven by a combination of injury severity, delayed access to care, crash context, and limited emergency and critical care capacity. Strengthening pre-hospital services, improving trauma care systems, and enhancing road safety measures are essential to reduce preventable deaths in similar resource-limited settings.