Traumatic brain injuries in civilian war victims in Afghanistan

Traumatic brain injuries (TBIs) are a common cause of morbidity and mortality in war zones. Currently, the vast majority of reports on war-related TBIs concern soldiers, and little is known about this condition in civilians.

This is a retrospective observational study from the EMERGENCY NGO hospital for civilian war victims in Kabul, Afghanistan. Data were gathered for all adults and children with war-related TBIs admitted between June and November 2021. The study aims to describe the epidemiology and clinical patterns of patients with war-related TBIs in a non-military context.

Out of a total of 1469 hospital admissions during the study period, 130 (8.8%) were war-related TBIs. Among these, 90 (69.2%) involved a penetrating brain injury. More than one-third of the study population were children aged 14 or younger (36.1%), and the most frequent cause of war-related TBIs was shells (58.1%). The median time from injury to admission was 3 hours (from 30 min to 3 days), with only 19% of patients presenting in the 'golden hour'. Neurosurgery was performed on 38 patients (29.2%), and 55 patients (42.3%) underwent mechanical ventilation. In-hospital mortality occurred in 35 patients (26.9%), including 15 do-not-resuscitate cases.

War-related TBIs were frequent among adults and children and had a high mortality rate. With more than one-third of patients undergoing mechanical ventilation, our data highlight that the availability of intensive care units with the ability to ventilate patients is of the utmost importance to save lives of civilians in areas of armed conflict.