Forensic analysis of traumatic brain injury management in Ukraine: A comparative study of pre-conflict and armed...

Armed conflict fundamentally alters trauma care structures. The full-scale invasion of Ukraine in 2022 created unprecedented challenges for traumatic brain injury (TBI) management, requiring rapid adaptation under extreme conditions.

To perform a forensic medical comparison of TBI management quality between pre-conflict (2012-2021) and conflict (2022-2024) periods, identifying factors affecting care and proposing improvements.

A retrospective forensic analysis of 3143 cases from Ukrainian bureaus was conducted. Statistical analysis included Chi-square, Student's t-test, and Mann-Whitney U test (p ≤ 0.05). Histopathological examinations verified causes of death and treatment adequacy.

The conflict period showed a marked increase in TBI severity: severe TBI rose from 12 ± 2.8% to 35 ± 3.4% (p < 0.001), while mild cases declined from 44 ± 2.1% to 25 ± 2.4%. Delays in care increased from 30.8 ± 12.8% to 45.0 ± 14.3% for isolated TBI and from 20.0 ± 14.4% to 50.0 ± 16.0% for TBI with acute hemorrhage. Absence of indicated surgery doubled (7.7 ± 7.4% to 15.4 ± 10.0%). Organizational defects rose from 34.2% (2021) to 52.3% (2024). Emergency hospitals saw patient loads increase from 20.0 ± 7.3% to 35.0 ± 8.4% for combined injuries.

Armed aggression degrades TBI care quality primarily through infrastructure damage and logistical disruptions. Findings emphasize the need for conflict-adapted protocols and resilient healthcare infrastructure. Implementing unified clinical-forensic standards will improve the accuracy of causal relationships in conflict-related TBI, providing a critical evidence base for strengthening global forensic services in war zones.