Combat-related Traumatic Brain Injury in Military Personnel: A Survival Analysis of Long-term Outcomes and Prognostic Factors in Saudi Arabia

Abstract Background: Traumatic brain injury (TBI) is a significant health concern for military personnel, with potential long-term consequences affecting functional outcomes and quality of life. This study aimed to analyse survival patterns and prognostic factors associated with combat-related TBI among Saudi Arabian military personnel over 4 years. Methods: We conducted a retrospective cohort study of 428 military personnel diagnosed with combat-related TBI between January 2021 and December 2024 at three major military medical centres in Saudi Arabia. Kaplan–Meier survival analysis was used to estimate overall survival and functional recovery rates. Cox proportional hazard models identified factors associated with mortality and functional outcomes. Competing risk analysis accounted for non-TBI-related deaths. Results: The 1-year, 2-year and 3-year survival rates were 92.3%, 87.6% and 84.1%, respectively. The median time to functional recovery was 14.2 months (95% confidence interval [CI]: 12.8–15.6). Severe TBI (hazard ratio [HR] = 3.42, 95% CI: 2.18–5.36, P < 0.001), age >40 years (HR = 1.86, 95% CI: 1.24–2.79, P = 0.003) and multiple trauma (HR = 2.14, 95% CI: 1.47–3.12, P < 0.001) were significant predictors of mortality. Early neurosurgical intervention (HR = 0.64, 95% CI: 0.45–0.91, P = 0.012) and neurorehabilitation (HR = 0.58, 95% CI: 0.41–0.82, P = 0.002) improved survival. Competing risk analysis showed that TBI-specific mortality decreased after the 1 st year, while non-TBI mortality remained constant. Conclusion: This study provides the first survival analysis of combat-related TBI in Saudi Arabian military personnel. Early intervention and neurorehabilitation improve outcomes. Identified prognostic factors can guide clinical decisions and resource allocation.