ArticleThe journal of trauma and acute care surgery2025
Time-limited association between plasma transfusion and mortality in pediatric traumatic brain injury.
Article in The journal of trauma and acute care surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Association between fresh frozen plasma transfusion and mortality stratified by Glasgow Coma Scale scores in isolated traumatic brain injury: a nationwide cohort study in Japan.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Blood Product Transfusion and Coagulopathy in Children with Traumatic Brain Injury: A Narrative Review.Children (Basel, Switzerland) · 2026Review
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Authors and funding
4 authors.
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Abstract
backgroundTraumatic 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.
methodsIn 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.
resultsOf 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.
conclusionThis 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.
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