Impact of War on the Structure and Severity of Traumatic Brain Injuries: Challenges for Forensic Medical Examination and Neurosurgical Care

Introduction. The war in Ukraine has led to a significant increase in the frequency and severity of traumatic brain injuries (TBIs), complicating their diagnosis, treatment, and forensic medical examination. Combat-related injuries exhibit distinct pathophysiological characteristics compared to pre-war trauma, necessitating adaptations in medical care standards and forensic injury assessment. Aim. To analyze changes in the structure and severity of TBIs caused by military actions in Ukraine, compare forensic medical examination indicators from the pre-war (2012–2021) and wartime (2022–2024) periods, and assess the effectiveness of medical care for victims. Materials and methods. The study is based on annual reports from the Bureau of Forensic Medical Examination of Ukraine (2019–2024). Statistical analysis included percentage ratio calculations, a 95% confidence interval, and a representativeness error. Data processing was performed using OpenOffice and GNU Octave. Results. The proportion of forensic medical examinations related to TBIs increased from 39.1% in the pre-war period to 55% in 2022–2024. The incidence of severe TBIs among victims rose from 12% to 35%. Cases of intracranial hemorrhages became more frequent (95.7% among corpses and 50.2% among victims). Brain tissue injuries increased from 34.5% to 45.8%. Regional analysis revealed a significant rise in trauma cases in eastern and southern Ukraine. Conclusions. The war has significantly altered the structure of TBIs, complicating forensic medical examination and increasing the demand for emergency neurosurgical care. The growing complexity of diagnostics and the rising incidence of severe injuries necessitate updating medical care standards, enhancing specialist training, and improving collaboration between forensic and clinical institutions.