Evidence map›Paper›PMID 30871608›Full record

Trial reportCritical care (London, England)2019

Transfusion requirements after head trauma: a randomized feasibility controlled trial.

André L N Gobatto, Milena A Link, Davi J Solla, Estevão Bassi, Paulo F Tierno, Wellingson Paiva, Fabio S Taccone, Luiz M Malbouisson

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02203292 (Transfusion Requirements After Head Trauma), which is not on this map. Cited by 50 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 11 pooled it
5.8field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT02203292 phase2completednot on this map

Transfusion Requirements After Head Trauma

TypeinterventionalSponsorUniversity of Sao PauloRan2014 to 2016Enrolled44ConditionsTraumatic Brain InjuryArmsLiberal transfusion strategy, Restrictive transfusion strategy
3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 11 syntheses or guidelines pooled it, 112 citations in OpenAlex.

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  9. Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

André L N GobattoInternal Medicine, Hospital São Rafael, Salvador, Brazil.
Milena A LinkSurgical Intensive Care Unit, Anesthesiology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Davi J SollaDivision of Neurosurgery, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
Estevão BassiTrauma Intensive Care Unit, Surgery Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Paulo F TiernoTrauma Intensive Care Unit, Surgery Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Wellingson PaivaDivision of Neurosurgery, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
Fabio S TacconeDepartment of Intensive Care, Erasme Hospital, Brussels, Belgium.
Luiz M MalbouissonSurgical Intensive Care Unit, Anesthesiology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. luiz.malbouisson@hc.fm.usp.br.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo · BRErasmus Hospital · BEHospital Alemão Oswaldo Cruz · BRHospital São Rafael · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined.

methodsAll eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy. The transfusion strategy was continued for up to 14 days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome.

resultsA total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.4 ± 1.0 and 9.3 ± 1.3 (p < 0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p = 0.02). There was negative correlation (r = - 0.265, p < 0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p < 0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p = 0.048) and the liberal group tended to have a better neurological status at 6 months (p = 0.06).

conclusionsThe trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group.

trial registrationClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.

Indexed as

AdultAnemiaBlood TransfusionBrazilCraniocerebral TraumaFeasibility StudiesFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedAnemiaTransfusionTraumatic brain injury

Identifiers

PMID30871608
PMCPMC6419414
OpenAlexW2937292883

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.