Haemoglobin levels, transfusion patterns, and associated outcomes in children with severe TBI : A secondary analysis from approaches and decisions in acute paediatric traumatic brain injury trial

Objective To evaluate the incidence of haemoglobin (Hgb) values <10 g/dL and transfusion in children with severe traumatic brain injury (TBI). Design Non‐prespecified secondary analysis using the Approaches and Decisions in Acute Paediatric TBI (ADAPT) trial (NCT04077411) that prospectively enrolled consecutive paediatric patients from February 2014 to September 2017. Setting U.S. and international sites with patient enrollment into ADAPT trial. Patients Patients less than 18 years old with a Glasgow Coma Scale (GCS) score less than or equal to 8 that had an intracranial (ICP) monitor and had at least one Hgb value recorded in the first 24 hours following ICP monitor placement. Interventions None. Measurements and Main Results Of the 997 patients included in the analysis, 895 (90%) had at least one Hgb value <10 g/dL during the study period. 607 (61%) patients received packed red blood cells (pRBCs) or whole blood transfusion, with 66% of transfusions occurring on ICU Day 1. The median blood transfusion volume (either pRBC or whole blood) in the study population was 15.2 mL/kg (IQR 10–27.1) within the first 7 days of ICU stay. In a multivariable logistic analysis, transfusion was associated with younger age, higher admission GCS score, increased clinical and injury severity at admission, and need for surgical intervention. However, neither nadir Hgb nor transfusion was associated with mortality or unfavorable neurologic outcome. Conclusions In a secondary analysis of ADAPT, both Hgb value <10 g/dL and transfusion were common in children with severe TBI. Nadir Hgb and transfusion were not associated with mortality or unfavourable neurologic outcomes. The optimal threshold for pRBC transfusion in children with severe TBI requires further study.