SynthesisIntensive care medicine2025
Liberal vs. restrictive transfusion strategies for acute brain injury: a systematic review and frequentist-Bayesian meta-analysis.
Synthesis in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 11 papers, 1 of them a synthesis that pooled 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.
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
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Liberal versus restrictive red blood cell transfusion thresholds in acute acquired brain injury: a systematic review and meta-analysis.BMJ open · 2025Pooled it
- Extracellular vesicles: A new therapeutic drug for nerve injury repair.Neural regeneration research · 2026Article
- Timing of Transfusion Strategy Initiation in Acute Brain Injury: A Subanalysis of the TRAIN Study.Neurocritical care · 2026Article
- Recommendations for implementing patient blood management-an updated modified Delphi consensus from a multidisciplinary expert panel in Hong Kong.Journal of anesthesia, analgesia and critical care · 2026Review
- Perioperative anemia and patient blood management in neurosurgery and neurocritical care: a narrative review.Journal of anesthesia, analgesia and critical care · 2026Review
- Effect of Red Blood Cell Transfusion on Cerebral Ischemia in Critically Ill Patients with Acute Brain Injury.Neurocritical care · 2025Article
- Liberal Versus Restrictive Transfusion Strategy in Patients With Subarachnoid Hemorrhage: A Meta-Analysis.Stroke (Hoboken, N.J.) · 2025Article
- Selection bias in the "TRAIN" randomized clinical trial: implications for meta-analyses-Author's reply.Intensive care medicine · 2025Article
- TRAIN study and transfusion strategies in brain injured patients.Intensive care medicine · 2025Article
- Selection bias in the "TRAIN" randomized clinical trial: implications for meta-analyses.Intensive care medicine · 2025Article
- Optimal fluid management for the surgical intensive care unit patient.Critical care science · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo determine whether a liberal transfusion strategy (≥ 9 g/dL) improves neurological outcomes in adults with acute brain injury (ABI).
methodWe systematically searched MEDLINE, EMBASE, the Cochrane Library, and trial registries for randomized controlled trials comparing liberal (≥ 9 g/dL) vs. restrictive (≥ 7 g/dL) transfusion in adults with ABI (traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage) and Glasgow Coma Scale ≤ 13. Frequentist, Bayesian, and trial sequential analyses were used. The primary outcome was favorable neurological status at 180 days.
resultsFour randomized controlled trials (N = 1853; 922 liberal, 931 restrictive) were included. The pooled frequentist risk ratio (RR) for favorable neurological outcome was 0.84 (95% CI 0.65-1.09; I
conclusionsThis review did not provide definitive evidence of a neurological benefit from liberal transfusion strategies in acute brain injury. Both frequentist and Bayesian analyses highlight the influence of a single trial on the overall effect estimate and heterogeneity. However, sensitivity analyses excluding this trial and focusing on studies with low risk of bias suggested that liberal transfusion strategies could improve neurological outcomes. Future research should focus on identifying patient subgroups most likely to benefit, guiding a more individualized approach.
Indexed as
Identifiers
39961845What OpenQuestion holds
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.