Impact of Armed Conflict on Traumatic Brain Injury: A Retrospective Comparative Study from Tigray, Northern Ethiopia

Abstract Background Traumatic brain injury (TBI) is a leading cause of death and disability, with the burden amplified in conflict zones where access to imaging and surgery may be compromised. The Tigray conflict (2020–2022) severely disrupted healthcare delivery in northern Ethiopia. Objective To evaluate how the Tigray conflict influenced the epidemiology, CT imaging access, and clinical outcomes of TBI. Methods We conducted a retrospective comparative study of TBI admissions to Ayder Comprehensive Specialized Hospital over three periods: pre-conflict (Nov 2019–Oct 2020), conflict (Nov 2020–Oct 2022), and post-conflict (Nov 2023–Oct 2024). Systematic random sampling from each period yielded 547 total charts; 487 met eligibility criteria. Variables included demographics, injury mechanism, GCS, CT findings, management, and in-hospital outcomes. Chi-square, Kruskal–Wallis, and multivariable logistic regression were applied. Results Median age was 25 years (IQR 20–38), and 88.7% were male. CT availability declined during conflict (81.6% pre vs. 68.8% during conflict, p < 0.001) and rebounded post-conflict (91.6%). Severe TBI increased from 20.5% pre-conflict to 44.3% during conflict (p < 0.001). In-hospital mortality was 13.8% (24/174) pre-conflict, 11.8% (20/170) during conflict, and 6.3% (9/143) post-conflict (p = 0.02). Conflict period, Severe TBI, and ICU admission were associated with 5.5 times, 4.9 times, and 9.8 times higher odds of hospital death, respectively. Depressed skull fracture and age were not significant; their P value are 0.209 and 0.251, respectively. Conclusion Armed conflict significantly increased TBI severity and reduced imaging availability. Conflict period, severe TBI, and ICU admission were strong independent predictors of in-hospital death.