•What is already known on the subjectGlobal morbidity and mortality from road traffic injuries (RTIs) are substantial, especially in low- and middle-income countries (LMICs) such as Kenya. RTIs have major economic impacts on households, communities, and nations.RTI surveillance is essential for characterizing the burden of and risk factors for RTIs, as well as for implementing and evaluating the impact of public health interventions aimed at reducing RTIs.Many countries, especially LMICs, lack a comprehensive national RTI surveillance system that consistently collects information on key variables necessary for public health action.•What this study addsWe found that RTIs in Nairobi County, an urban setting in Kenya, predominantly affected males and young adults, and we observed that nonuse of safety equipment (i.e., seat belts and helmets) among RTI cases was common.Our study demonstrates that a hospital-based RTI surveillance system is practical in LMIC settings and can provide critical information to guide public health practice and policy. This pilot study also elucidates some challenges related to collecting information on circumstances contributing to RTIs and the need for innovative ways to systematically collect this vital information. Kenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018–April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1–89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.