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
. 2025 Jun 6:10.1097/TA.0000000000004694.
doi: 10.1097/TA.0000000000004694. Online ahead of print.

Time-limited association between plasma transfusion and mortality in pediatric traumatic brain injury

Leah Furman  1 , Erin V Feeney, Barbara A Gaines, Christine M Leeper
Affiliations

Time-limited association between plasma transfusion and mortality in pediatric traumatic brain injury

Leah Furman et al. J Trauma Acute Care Surg. .

Abstract

Background: Traumatic brain injury (TBI) is a predominant cause of pediatric mortality. While prehospital plasma administration has been associated with lower mortality in adults with TBI, the impact of early plasma in children is unknown.

Methods: In this retrospective cohort study, we examined the impact of plasma transfusion within 4 hours of arrival on 4-hour, 24-hour, and 30-day mortality in children aged 1 to 17 years with severe TBI (head Abbreviated Injury Scale scores 4 and 5) using the National Trauma Data Bank from 2020 to 2022. We excluded subjects with mild-moderate or nonsurvivable TBI or missing plasma or weight data. Cox proportional hazard models, clustered by facility, assessed the effect of early plasma on mortality, adjusting for: age; sex; trauma mechanism; interfacility transfer; shock; total Glasgow Coma Scale; Injury Severity Score; trauma center level; insurance; binary whole blood, red blood cell, and platelet administration; and weight-adjusted total 4-hour transfusion volumes.

Results: Of 367,065 children in the National Trauma Data Bank from 2020 to 2022, 14,691 met the inclusion criteria, of whom 1,594 (10.9%) received early plasma. Subjects were mostly male (67.8%), with a median (interquartile range) age of 12 (5-15) years, Glasgow Coma Scale score of 11 (3-15), Injury Severity Score of 25 (17-29), and 28.7% presenting in shock. The adjusted hazard ratio (HR) for the effect of plasma administration on mortality was 0.610 (95% CI, 0.430-0.864; p = 0.005) at 4 hours, 0.894 (95% CI, 0.706-1.131; p = 0.350) at 24 hours, and 1.132 (95% CI, 0.961-1.334; p = 0.138) at 30 days.

Conclusion: This study reports a significant association between early plasma administration and a lower risk of 4-hour mortality among children with severe TBI that does not persist at or beyond 24 hours. While these data suggest that plasma resuscitation may extend the window for lifesaving intervention, additional prospective data are needed.

Level of evidence: Therapeutic/Care Management; Level III.

Keywords: Plasma; pediatric trauma; plasma resuscitation; traumatic brain injury.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare no relevant conflicts of interest. JTACS COI Disclosure forms for all authors have been supplied and are provided as Supplemental Digital Content 1.

Similar articles

See all similar articles

References

    1. Hung KL. Pediatric abusive head trauma. Biomed J. 2020;43(3):240–250. - PMC - PubMed
    1. Araki T, Yokota H, Morita A. Pediatric traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir (Tokyo). 2017;57(2):82–93. - PMC - PubMed
    1. Haarbauer-Krupa JK, Glang A, Kurowski B, Breiding MJ. Report to Congress: The Management of Traumatic Brain Injury in Children. Centers for Disease Control and Prevention. Atlanta, GA. https://stacks.cdc.gov/view/cdc/51852. Published 2018. Accessed January 15, 2025.
    1. Lucisano AC, Leeper CM, Gaines BA. Trauma-induced coagulopathy in children. Semin Thromb Hemost. 2020;46(2):147–154. - PubMed
    1. Leeper CM, Strotmeyer SJ, Neal MD, Gaines BA. Window of opportunity to mitigate trauma-induced coagulopathy: fibrinolysis shutdown not prevalent until 1 hour post-injury. Ann Surg. 2019;270(3):528–534. - PubMed

LinkOut - more resources