A. Nguyen2, D. Plurad1, A. Kaji3, S. Bricker1, A. Neville1, F. Bongard1, B. Putnam1, D. Kim1 1Harbor-UCLA Medical Center,Division Of Trauma/Acute Care Surgery/Surgical Critical Care,Torrance, CA, USA 2Harbor-UCLA Medical Center,Department Of Surgery,Torrance, CA, USA 3Harbor-UCLA Medical Center,Department Of Emergency Medicine,Torrance, C, USA
Introduction: The optimal transfusion threshold for patients with traumatic brain injury (TBI) is not well defined. The purpose of this study was to examine the impact of a liberal versus restrictive transfusion strategy (RTS) on outcomes in patients with TBI. We hypothesized that a RTS is not associated with mortality in TBI patients.
Methods: We performed a retrospective cohort analysis of adult patients with TBI over a 40-month period. Patients with an Abbreviated Injury Scale (AIS) ≥3 in 2 or more regions outside of the head and those patients who did not undergo transfusion were excluded. Liberal transfusion strategy (LTS) patients received packed red blood cells for a hemoglobin ≤10 mg/dL whereas as RTS patients were not transfused until their Hb was ≤7 mg/dL. Multivariate logistic regression analysis was performed to identify independent predictors of mortality.
Results: Of 103 patients, 61 patients (59%) underwent a LTS and 42 patients (41%) underwent a RTS. Both groups were similar in age, gender, injury severity, and head AIS scores. There was no difference in the number of patients with severe TBI between the RTS and LTS groups (50% vs. 46%, p=0.7). On unadjusted analysis, there was no difference in mortality (31% vs. 38%, p=0.5) or complications (20% vs. 18%, p=0.8) between groups. On multivariate logistic regression analysis, age (OR=1.03; 95%CI=1.00-1.05, p=0.02), head AIS (OR=2.4; 95%CI=1.2-5.1, p=0.02), and subarachnoid hemorrhage (OR=3.6; 95%CI=1.3-10.3, p=0.02) were the only independent predictors of mortality.
Conclusion: A restrictive transfusion strategy may be safe in patients following isolated TBI. Prospective multicenter studies are required before any definitive recommendations regarding a restrictive transfusion strategy can be set forth.