Trauma Profiles and Treatment of War-Wounded Patients in a Role 4 Hospital in Ukraine: A Three-Year Retrospective Analysis

Introduction: The war in Ukraine has forced hospitals near the frontlines to overcome a considerable number of complex injuries under challenging conditions. This study presents a comprehensive analysis of 7,758 war-wounded patients admitted to the first traumatological Intensive Care Unit of Mechnikov Hospital in Dnipro, Ukraine, a civilian hospital acting as the main role 4 facility for the eastern and southern zones, between 2022 and 2024. Methods: A retrospective two-tiered study design was employed. The first tier analyzed automated hospital records for all war-wounded patients, focusing on demographics, mechanisms of injury, injury severity, and outcomes. The second tier consisted of a manual review of 41 detailed patient files to provide in-depth clinical insights. Metrics included injury patterns, prehospital interventions, surgical procedures, and ICU mortality rates. Results: Explosive injuries accounted for the majority of cases across all years (93.2% in 2022, 93.7% in 2023, and 88.5% in 2024), with a rising proportion of gunshot wounds (2.5% in 2022 to 7.5% in 2024). Median patient age was 38 (IQR 30–47), and the median length of hospital stay was three days (IQR 2–5). Limb injuries (87.8%) were the most common, followed by head (58.5%), thoracic (51.2%), and abdominal injuries (26.8%). ICU mortality rates declined over time, from 6.8% in 2022 to 5.4% in 2024. Prehospital interventions were prevalent, notably intubation (82.9%), tourniquet (65.9%), and damage-control surgery (70.7%). Conclusion: The study highlights the prevalence of blast-induced polytrauma, emphasizing the importance of prehospital interventions and damage-control surgery in reducing mortality, but shows an evolution of the proportion of gunshot wounds over time. While ICU mortality rates compare favorably with other conflict zones, a declining trend over the years seems to follow the adaptation of therapeutic and logistical procedures. Limitations include the exclusion of prehospital fatalities and challenges in data collection due to major resource and environmental constraints.