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Original research
Traumatic brain injuries in civilian war victims in Afghanistan
  1. Ornella Spagnolello1,2,
  2. Silvia Fabris3,
  3. Shekiba Esmati1,
  4. Arezo Dost1,
  5. Muhebullah Ahmadzai1,
  6. Ahmad Khan Aryan1,
  7. Sofia Gatti4,
  8. Manuela Cormio4,
  9. Gina Portella4,
  10. Martina Baiardo Redaelli1,5
  1. 1 Intensive Care Unit, Kabul, Afghanistan, EMERGENCY Ong Onlus, Milan, Italy
  2. 2 Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Rome, Italy
  3. 3 Migrant and Global Health Research Organization (MiHeRO), Rome, Italy
  4. 4 Medical Division, EMERGENCY Ong Onlus, Milan, Italy
  5. 5 Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
  1. Correspondence to Dr Ornella Spagnolello; spagnolello.ornella{at}gmail.com

Abstract

Background 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.

Methods 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.

Results 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.

Conclusions 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.

  • trauma
  • epidemiology
  • critical care
  • craniocerebral trauma

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/emermed-2024-214127

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Jason E Smith

    • X @baiardomartina

    • Contributors All the authors vouched for the accuracy of the reported data. OS, GP, MC and MBR contributed to the design and writing of the manuscript. SF and SG contributed to the data analysis and drafting of the statistical sections of the manuscript. SE, MA, AD and AKA contributed to data collection. All authors revised and approved the manuscript. OS and MBR were responsible for the overall content as guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.