(1726) Transfusion Strategy in Traumatic Brain Injury: A Meta-analysis of Randomized Clinical Trials

Introduction: Anemia is a detrimental condition for traumatic brain injury (TBI), however there is no clear recommendation on the transfusion threshold for safe hemoglobin (Hb) levels. We aim to conduct a systematic review and meta-analysis comparing transfusion benefits between Hb ≤ 10 g/dL (liberal) and Hb ≤ 7 g/dL (restrictive) in patients with TBI.

Methods: PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) that compared liberal versus restrictive transfusion strategy in patients with TBI. The reported outcomes were (1) mortality, (2) unfavorable Glasgow outcome scale (GOS), (3) red blood cell units per patient and (4) length of stay (LOS) at hospital. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. Heterogeneity was examined with I² statistics. Statistical analysis was done using Review Manager 5.4.1.

Results: We included four RCTs with a total of 1,047 patients, of whom 529 (50.5%) underwent a liberal transfusion strategy. The follow-up period ranged from one to six months. There were no significant differences between the groups in terms of mortality (OR 1.03; 95% CI 0.77-1.37; p=0.86; I²=30%), unfavorable GOS scores (OR 0.95; 95% CI 0.72-1.24; p=0.69; I²=76%), the number of red blood cell units transfused per patient (OR -1.59; 95% CI -3.41-0.23; p=0.09; I²=94%), and LOS at hospital (OR -0.41; 95% CI -3.99-3.16; p=0.82; I²=0%).

Conclusions: Our meta-analysis of RCTs suggests that in critically ill patients with TBI and anemia, there is no difference in liberal or restrictive transfusion threshold.