Evidence map›Paper›PMID 42565997›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026

Early calcium replacement after minimal blood transfusion is associated with adverse outcomes.

W Preston Hewgley, Russell L Griffin, Emily Baird, Zain G Hashmi, Samantha J Baker, Jan O Jansen, Jeffrey Kerby, John B Holcomb, Rondi B Gelbard

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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

W Preston HewgleyDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA. wphewgley@uabmc.edu.ORCID https://orcid.org/0009-0007-4465-0784
Russell L GriffinDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Emily BairdDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Zain G HashmiDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Samantha J BakerDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Jan O JansenDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Jeffrey KerbyDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
John B HolcombDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.
Rondi B GelbardDepartment of Trauma and Acute Care Surgery, University of Alabama at Birmingham, 1808 7th Ave S., 615 Boshell Diabetes Bldg D673B, Birmingham, AL, 35233, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCalcium disturbances are common in patients with traumatic injuries, exacerbated by shock and blood product resuscitation. Recently, empiric calcium supplementation has been recommended with the first unit of blood transfusion, despite a lack of data supporting this practice. We hypothesize that there are risks associated with calcium administration in patients receiving small volume transfusion.

methodsThis is a retrospective review of patients admitted to our Level 1 trauma center from 2018 to 2024 who received 1-3 units of red blood cells (RBCs). Patients were stratified by calcium levels and whether they received early calcium supplementation. A logistic regression was used to estimate odds ratios for the association between calcium levels, calcium supplementation, and outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury, myocardial infarction, acute respiratory distress syndrome, and venous thromboembolism. The model was adjusted for age, sex, ISS and shock index.

resultsA total of 2,680 patients were included. When stratified by calcium levels and supplementation status, patients were similar in terms of age, sex, mechanism and injury severity score, but shock index was higher among patients receiving calcium supplementation. After adjustment, hypocalcemic patients who received calcium supplementation had higher odds of developing acute kidney injury, acute respiratory distress syndrome, deep vein thrombosis, and pulmonary embolism (all p < 0.05).

conclusionIn trauma patients who received 1-3 units of RBCs, early calcium supplementation was associated with adverse outcomes. The use of early, empiric calcium supplementation in conjunction with minimal transfusion should be carefully considered.

Indexed as

Blood TransfusionCalciumErythrocyte TransfusionHypocalcemiaWounds and InjuriesAdultFemaleHospital MortalityHumansInjury Severity ScoreMaleMiddle AgedRespiratory Distress SyndromeRetrospective StudiesCalciumEarly calciumEmpiric calciumTransfusion-related hypocalcemia

Identifiers

PMID42565997
PMCPMC13451501

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