Impact of War on Traumatic Brain Injury and Access to Imaging: A Retrospective Comparative Study from a Tertiary Referral Centre

Traumatic brain injury is a leading cause of death and disability, with the burden particularly severe in low and middle-income countries where access to imaging is often limited. Wars can further disrupt healthcare systems by restricting supplies, electricity, and skilled staff, making imaging access even more fragile. This study examined how the war in Tigray, northern Ethiopia, affected the care of patients with traumatic brain injury at a major referral hospital. We reviewed 487 patient charts across three periods: before the war, during the war, and after the war. The median age was 25 years, and most patients were men. Access to CT scans fell during the war compared to before, but improved again after the war. Severe traumatic brain injury became much more common during the war, while surgical operations increased most after the war. Hospital deaths were highest before and during the war, but declined after the war. In the adjusted analysis, admission during the war, severe injury, and intensive care admission were all strong predictors of death. These findings show how war strains imaging services and worsens outcomes for brain injury, highlighting the need to protect radiology and trauma systems during crises.