Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 1;53(4):e963-e972.
doi: 10.1097/CCM.0000000000006585. Epub 2025 Jan 29.

Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Anna Laura Lima Larcipretti  1 , Ofonime Chantal Udoma-Udofa  2 , Fernando Cotrim Gomes  3 , Jéssica Sales de Oliveira  4 , Elizabet Taylor Pimenta Weba  5 , Deivyd Vieira Silva Cavalcante  6 , Madhav Kiritbhai Dharaiya  7 , Matheus de Andrade Bannach  8
Affiliations
Meta-Analysis

Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Anna Laura Lima Larcipretti et al. Crit Care Med. .

Abstract

Objectives: Balancing oxygen requirements, neurologic outcomes, and systemic complications from transfusions in traumatic brain injury (TBI) patients is challenging. This review compares liberal and restrictive transfusion strategies in TBI patients.

Data sources: Electronic databases were searched from inception to October 2024.

Study selection: We included randomized controlled trials comparing liberal and restrictive transfusion strategies in TBI patients.

Data extraction: Data were extracted by two reviewers using predefined forms.

Data synthesis: We included five studies with 1,533 patients: 769 (50.2%) in the liberal transfusion group and 764 (49.8%) in the restrictive group. There were no significant differences between groups favorable Glasgow Outcome Scale (risk ratio [RR], 1.16; 95% CI, 1.00-1.34), although a leave-one-out analysis demonstrated significance in this endpoint (RR, 1.24; 95% CI, 1.06-1.45). No significant difference was found regarding hospital mortality (RR, 0.98; 95% CI, 0.76-1.27), mortality at follow-up (RR, 1.03; 95% CI, 0.82-1.28), mortality in the ICU (RR, 1.00; 95% CI, 0.73-1.37), infection rates (RR, 1.08; 95% CI, 0.95-1.23), thromboembolic events (RR, 1.79; 95% CI, 0.74-4.31), hospital length of stay (LOS) (mean difference [MD], -1.45; 95% CI, -4.85 to 1.96), or ICU LOS (MD, -0.47; 95% CI, -3.84 to 2.91). The liberal transfusion strategy group had a significantly higher prevalence of acute respiratory distress syndrome (RR, 1.78; 95% CI, 1.06-2.98) and received more blood units per patient (MD, 2.62; 95% CI, 1.90-3.33).

Conclusions: Our findings suggest that a liberal transfusion strategy results in better neurologic outcomes than a restrictive approach. Future research should examine the complication profile and the effects of using a 9 g/dL threshold. We advocate for revising current guidelines to establish 9 g/dL as the standard threshold for transfusions in TBI patients.

Keywords: anemia; critical care; meta-analysis; transfusion; traumatic brain injury.

PubMed Disclaimer

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

References

    1. GBD Spinal Cord Injuries Collaborators: Global, regional, and national burden of spinal cord injury, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019 [published correction appears in Lancet Neurol. 2024 Apr;23(4):e8. doi: 10.1016/S1474-4422(24)00095-4]. Lancet Neurol. 2023; 22:1026–1047
    1. Salim A, Hadjizacharia P, DuBose J, et al.: Role of anemia in traumatic brain injury. J Am Coll Surg. 2008; 207:398–406
    1. van de Wiel A: Anemia in critically ill patients. Eur J Intern Med. 2004; 15:481–486
    1. Zhou JK, Zhang QS, Chen YQ, et al.: Use of hematocrit for short-term prognosis of patients with traumatic brain injury after decompressive craniectomy. World Neurosurg. 2019; 123:e141–e146
    1. Sekhon MS, McLean N, Henderson WR, et al.: Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury. Crit Care. 2012; 16:R128

MeSH terms