Trial reportThe journal of trauma and acute care surgery2013
Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes.
Trial report in The journal of trauma and acute care surgery, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis.BMJ (Clinical research ed.) · 2015Pooled it
- Trial
- The Impact of Hemoglobin Transfusion Thresholds in Moderate-to-Severe Blunt Traumatic Brain Injury on 6-Month Neurologic Outcomes: A Systematic Review and Meta-Analysis.Neurology international · 2026Article
- Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality.Transfusion · 2025Article
- Haemoglobin values, transfusion practices, and long-term outcomes in critically ill patients with traumatic brain injury: a secondary analysis of CENTER-TBI.Critical care (London, England) · 2024Observational
- Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence.Neurotrauma reports · 2022Article
- Choice of Whole Blood versus Lactated Ringer's Resuscitation Modifies the Relationship between Blood Pressure Target and Functional Outcome after Traumatic Brain Injury plus Hemorrhagic Shock in Mice.Journal of neurotrauma · 2021Article
- Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice.Neurocritical care · 2021Article
- Effect of Red Blood Cell Storage Duration on Outcomes of Isolated Traumatic Brain Injury.Medical science monitor : international medical journal of experimental and clinical research · 2020Article
- Clinical Significance of Nadir Hemoglobin in Predicting Neurologic Outcome in Infants With Abused Head Trauma.Frontiers in pediatrics · 2020Article
- Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018.The Southern African journal of critical care : the official journal of the Critical Care Society · 2020Article
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.Critical care (London, England) · 2019Article
- Transfusion practices in traumatic brain injury.Current opinion in anaesthesiology · 2018Review
- Polynitroxylated Pegylated Hemoglobin-A Novel, Small Volume Therapeutic for Traumatic Brain Injury Resuscitation: Comparison to Whole Blood and Dose Response Evaluation.Journal of neurotrauma · 2017Article
- Observational
- A Derivation and Validation Study of an Early Blood Transfusion Needs Score for Severe Trauma Patients.Journal of clinical medicine research · 2016Article
- Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury.Neurocritical care · 2016Article
- The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition.Critical care (London, England) · 2016Article
- Transfusion in Traumatic Brain Injury.Current treatment options in neurology · 2015Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundRed blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established.
methodsA retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] < 70 or SBP of 70 to 90 with a heart rate ≥108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndrome-free survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled using multivariable logistic regression with robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level.
resultsA total of 1,158 patients had a mean age of 40, 76% were male, and 98% experienced blunt trauma. The initial mean GCS score was 5, and the initial mean SBP was 134. The mean head Abbreviated Injury Scale (AIS) score was 3.5. A categorical interaction of red blood cell transfusion stratified by initial Hgb showed that when the first Hgb was greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p < 0.01) and decreased adult respiratory distress syndrome-free survival (odds ratio, 0.82; 95% CI, 0.74-0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p < 0.01).
conclusionIn patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10. LEVEL OF EVIDENCE: Therapeutic study, level III.
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