Scholarlink

Purpose <p>In moderate-to-severe traumatic brain injury (TBI), anemia may exacerbate secondary cerebral injury, and patients with multiple trauma may be especially vulnerable to cerebral hypoxia. We conducted a secondary analysis of the HEMOTION trial (liberal transfusion strategy &gt; 10&#xa0;g/dL vs. restrictive &gt; 7&#xa0;g/dL), to assess whether multiple trauma modifies the effect of transfusion strategy after moderate-to-severe TBI.</p> Methods <p>We included all HEMOTION trial participants (n = 742) and defined multiple trauma using three definitions: (1) extracranial injury with Injury Severity Score (ISS) &gt; 15; (2) extracranial injury requiring emergency extracranial surgery; (3) spinal injury with neurological deficit. The primary outcome was the 6-month Glasgow Outcome Scale Extended (GOS-E). We tested interactions between transfusion strategy and multiple trauma status using sliding dichotomy and hierarchical Poisson regression, with sensitivity analyses using classical dichotomy (GOS-E ≤ 4) and proportional odds models. Secondary outcomes included mortality, quality of life (EQ-5D-5L, QOLIBRI), functional independence (FIM), and depression (PHQ-9).</p> Results <p>We found no interaction between multiple trauma status and transfusion strategies on the 6-month GOS-E across all three definitions. The adjusted relative risk (RR) of an unfavourable outcome with the liberal strategy was 0.87 (95% CI 0.71–1.07) for patients with ISS &gt; 15, 0.79 (0.59–1.05) for emergency extracranial surgery, and 0.99 (0.42–2.33) for spinal cord injury. Sensitivity analyses suggested a potential interaction for patients undergoing emergency extracranial surgery (p-interaction = 0.02 for proportional odds analysis; 0.05 for classical dichotomy). A liberal strategy was associated with better FIM, EQ-5D-5L, and Qolibri scores for definitions 1 and 2, but not 3, with no consistent interaction. Mortality and PHQ-9 did not differ.</p> Conclusion <p>Multiple trauma status was not associated with the effect of liberal vs. restrictive transfusion strategies on the GOS-E. Patients requiring emergency extracranial surgery may warrant further investigation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury: a sub-study of the HEMOTION trial

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月1日

查看全文
  • Marwan Bouras,
  • François Lauzier,
  • Dean A. Fergusson,
  • Xavier Neveu,
  • Lucy Clayton,
  • Marie-Pier Patton,
  • Olivier Costerousse,
  • Shane W. English,
  • Annemarie Docherty,
  • Luiz M. S. Malbouisson,
  • Ryan Zarychanski,
  • Lynne Moore,
  • Paule Lessard Bonaventure,
  • Vincent Laroche,
  • Michael Verret,
  • Damon C. Scales,
  • Neill K. J. Adhikari,
  • Jonathan Greenbaum,
  • Andreas Kramer,
  • Vanesa Garnelo Rey,
  • Ian Ball,
  • Kosar Khwaja,
  • Matt Wise,
  • Daniel Harvey,
  • Russell Chabanne,
  • Julien Pottecher,
  • Jonathan Rhodes,
  • Andrea Rigamonti,
  • Karen E. A. Burns,
  • Donald E. Griesdale,
  • Demetrios James Kutsogiannis,
  • Robert Green,
  • J. Gordon Boyd,
  • Frederick Zeiler,
  • Alwyn Gomez,
  • Emmanuel Charbonney,
  • Timothy Astles,
  • Eric Sy,
  • Alexis F. Turgeon,
  • David Bellemare,
  • Marie-Claude Boulanger,
  • Éric Brassard,
  • Ève Cloutier,
  • Olivier Costerousse,
  • Line Côté,
  • Émilie Couillard-Chénard,
  • Rana Daher,
  • Marjorie Daigle,
  • Charles Delisle-Thibault,
  • Charles Francoeur,
  • Stéphanie Grenier,
  • Gabrielle Guilbault,
  • Chartelin Jean Isaac,
  • Laura Labbé,
  • Vincent Laroche,
  • François Lauzier,
  • Guillaume LeBlanc,
  • Caroline Léger,
  • Paule Lessard Bonaventure,
  • Louis-Charles Mallard,
  • Bohdana Marandyuk,
  • Stéphanie Massana,
  • Stéphanie Nadeau-Caplette,
  • Isabelle St-Hilaire,
  • Maude St-Onge,
  • Antoine Tremblay,
  • Marie-Claude Tremblay,
  • Alexis Turgeon,
  • Michael Verret,
  • Marie-Ève Caron,
  • Léa Durocher,
  • Josée Loranger,
  • Jean-François Naud,
  • Élise Rodrigue,
  • Danielle Tapps,
  • Jean-Nicholas Dubé ,
  • Julie Belisle ,
  • Marie-Pier Bouchard ,
  • Elaine Carbonneau ,
  • Line Côté ,
  • Frédérick D’Aragon ,
  • Ilyona D’Hervé,
  • Justine Grégoire,
  • Marilène Ladouceur,
  • Joannie Marchand,
  • Marie-Hélène Masse,
  • Dominique Pellerin,
  • Yannick Poulin,
  • Hector Quiroz,
  • Charles St-Arnaud,
  • François Lamontagne,
  • Norine Alam,
  • Josie Campisi,
  • Dan Deckelbaum,
  • Jeremy Grushka,
  • Ashwini Gursahaney,
  • David Hornstein,
  • Dev Jayaraman,
  • Laureen Mian,
  • Aasmine Kaur,
  • Raham Rahgoshai,
  • Rayhaneh Rahgoshai,
  • Tarek Razek,
  • Robert Salisidis,
  • Jason Shahin,
  • Patrizia Zanelli,
  • Kosar Khwaja,
  • Fatna Benettaib,
  • Dounia Boumahni,
  • Katherine Coutu-Beadry,
  • Ali Ghamraoui,
  • Melissa Gagnon-Hamelin,
  • Francesca Lamothe,
  • Martine Lebrasseur,
  • Cindy Prie,
  • Maya Salame,
  • Michaël Chassé,
  • Alana Aimable-Brathwaite,
  • Rachel Cloutier,
  • Michelle Cummings,
  • Dean Fergusson,
  • Brigette Gomes,
  • Jessica Haines,
  • Liane Leclair,
  • Rebecca Porteous,
  • Kristy Steeves,
  • Angie Tuttle,
  • Amanda Van Beinum,
  • Irene Watpool,
  • Jennifer Xin,
  • Shane English,
  • Kowsiya Jeganathan,
  • Draga Jichici,
  • Amanda Martyniuk,
  • Maureen Meade,
  • Sunjay Sharma,
  • Almunder Algrid,
  • Eileen Campbell,
  • Rebecca Rondinelli,
  • Laura Winters,
  • Irina Zaborovskaya,
  • Ian Ball,
  • Tracy Boyd,
  • Ilinca Georgescu,
  • Michaela Hanley,
  • Miranda Hunt,
  • Gordon Boyd,
  • Andrew Baker,
  • Karen Burns,
  • Eryn Churcher,
  • Jennifer Hodder,
  • Imrana Khalid,
  • John Marshall,
  • Gyan Sandhu,
  • Marlene Santos,
  • Andrea Rigamonti,
  • Neill K. J. Adhikari,
  • Martin Chapman,
  • Connie Colavecchia,
  • Brian Cuthbertson,
  • Robert Fowler,
  • Maneesha Kamra,
  • Hamzah Khan,
  • Nicole Marinoff,
  • Thivya Sabananthan,
  • Thuva Sugumaran,
  • Damon Scales,
  • Denise Foster,
  • Naisan Garraway,
  • Rebecca Grey,
  • Mypinder S. Sekhon,
  • Donald E. Griesdale,
  • Fiona Auld,
  • Colin Casault,
  • Jessica Craighead,
  • Gayle Garney,
  • Daniel Ovakim,
  • Deb Parfett,
  • Gordon Wood,
  • Soumya Alias,
  • Shelby Browne,
  • Gloria Vazquez-Grande,
  • Alwyn Gomez,
  • Justin Lys,
  • Nicole Marten,
  • Dina Muhammad,
  • Maggie Wilson,
  • Frederick Zeiler,
  • Ryan Zarychanski,
  • Cassidy Codan,
  • Philippe Couillard,
  • Olesya Dmitrieva,
  • Lily Guan,
  • Lois Hagan,
  • Leora Hiar,
  • Julie Kromm,
  • Aimie Lee,
  • Kira Makuk,
  • Luis Alfonso Ortiz,
  • Justine Reyes,
  • Stacy Rudell,
  • Andreas Kramer,
  • Tayne Hewer,
  • Mike Jacka,
  • Arabesque Parker,
  • Patrica Thompson,
  • Demetrios James Kutsogiannis,
  • Valerie Barrette,
  • Mete Erdogan,
  • Diana Gillis,
  • Osama Loubani,
  • Laura Magennis,
  • Edmund Tan,
  • Robert Green,
  • Jenna England,
  • Chiraag Gupta,
  • James Lee,
  • Jonathan Mailman,
  • Sandy Kassir,
  • Eric Sy,
  • Peter Andrews,
  • Maria Amamio,
  • Lucy Barclay,
  • Sophie Birch,
  • Kate Briton,
  • Sarah Clark,
  • Katherine Doverman,
  • John Emelifeonwu,
  • David Hope,
  • Jo Singleton,
  • Lucy Marshall,
  • Scott Simpson,
  • Nicola Rea,
  • Corrienne McCulloch,
  • Jonathan Rhodes,
  • Timothy Walsh,
  • Hayley Gagiano,
  • Jessica Jones,
  • Joanne Morley,
  • Evie Headlam,
  • Keith Hugill,
  • Lauren Simpson,
  • Amy Thompson,
  • Judith Wright,
  • Nikolaidis Athanasios,
  • Alice Baddeley,
  • Anthony Baidoo,
  • Amy Clark,
  • Louise Conner,
  • Martin Dent,
  • Sonya Finucane,
  • David Ford,
  • Alexandra Gibbins,
  • Treesa Joseph,
  • Margaret Langley,
  • Sally Maitland,
  • Lisa McLoughlin,
  • Megan Meredith,
  • Lucy Morris,
  • Cecilia Peters,
  • Nick Plummer,
  • Lucy Ryan,
  • Julia Sampson,
  • Dawn Spîck,
  • Jeloos Haghi Theerata,
  • Anju Thomas,
  • Catherine Walton,
  • Daniel Harvey,
  • Sharon Barber,
  • Billie Barratt,
  • Nathan Butterworth,
  • Laura Catlow,
  • Kathryn Cawley,
  • Bethan Charles,
  • Joy Dearden,
  • Reece Doonan,
  • Louise Harrison,
  • Dominic Kay,
  • Stephanie Lee,
  • Diane Lomas,
  • Chloe Lyons,
  • Danielle McLaughlan,
  • Angiy Vian-Michael,
  • Dahlia Morris,
  • Jessica Pendlebury,
  • Jane Perez,
  • Neda Shahedy,
  • Melanie Slaughter,
  • Anila Sukumaran,
  • Lisa Swindells,
  • Jonathan Greenbaum,
  • Jenny Brooks,
  • Jia Cheung,
  • Jade Cole,
  • Jacqueline Curtin,
  • Michelle Davies,
  • Rhys Davies,
  • Lauren Hunt,
  • Helen Hill,
  • Aneesa Nawaz,
  • Emma Thomas,
  • Angharad Williams,
  • Matt Wise,
  • Ziortza Fernandez de Pinedo Artaraz,
  • Dorota Banach,
  • Phoebe Coghlan,
  • Anita Tamang Gurung,
  • Eleanor Jepson,
  • Amal Mohammed,
  • Roceld Rojo,
  • Sonia Sousa Arias,
  • Maie Templeton,
  • Jenny Wong,
  • Vanesa Garnelo Rey,
  • Lucy Bailey,
  • Omar Bani-Saad,
  • Moses Chikungwa,
  • Felicity Clark,
  • Nick Coleman,
  • Michelle Davies,
  • Ingi Elsayed,
  • Minerva Gellamucho,
  • Joanne Hidden,
  • Steve Lord,
  • Mia Marsden,
  • Ram Matsa,
  • Nehal Patel,
  • Fernando Rodriguez-Albarran,
  • Elisa Sernicola,
  • Christopher Thompson,
  • Stephan Krueper,
  • Ian Turner-Bone,
  • Amie Reddy,
  • Laura Wilding,
  • Timothy Astles,
  • John Broad,
  • Jennifer Cater,
  • Victoria Empson,
  • Clare Fletcher,
  • Jimmy Gordon,
  • Sikhangezile Gwatikunda,
  • Michael Jennings,
  • Jonathan McGregor,
  • Stephen Nicholls,
  • Vijai Paulsen,
  • Rebecca Russel,
  • Gerald Smith,
  • Katy Walker,
  • Gilian Williams,
  • Priya Nair,
  • Yannick Brunin,
  • Laurent Carteron,
  • Cyrielle Despres,
  • Emmanuel Genestier,
  • Marc Ginet,
  • Dejan Ilic,
  • Sandra Paillot,
  • Pierre-Alain Poinsot,
  • Lucie Vettoretti,
  • Sébastien Pili-Floury,
  • Julien Amat,
  • Élodie Caumon,
  • Laura Chiodetti,
  • Aurélie Masgrau,
  • Pierre-Antoine Pioche,
  • Benjamin Rieu,
  • Christine Rolhion,
  • Russell Chabanne,
  • Gaëlle Arfeuille,
  • Baptiste Bouchier,
  • Stéphane Hecketsweiler,
  • Fanny Planquart,
  • Arnaud Romoli,
  • Hakim Tayebi,
  • Thien-Nga Chamaraux-Tran,
  • Alain Meyer,
  • Magdalena Szczot,
  • Julien Pottecher,
  • Audrey Ambert,
  • Loubna Elotmani,
  • Sophie Lloret,
  • Laurent Muller,
  • Jean-Yves Lefrant,
  • Claire Roger,
  • Fabiana Agena,
  • Vivian Henriques Do Amaral,
  • Ana Paula Carvalho Canela Balzi,
  • Catherine Oliveira,
  • Wellingson Paiva,
  • Fabiane Aliotti Regalio,
  • Roberta Figueiredo Vieira Bento,
  • Luiz Marcelo Sá Malbouisson,
  • Cristina Amendola,
  • Tiago Andrade,
  • Jacqueline Borges,
  • Beatriz Costa Duarte da Conceição,
  • Fernando Rodrigues Da Silva,
  • Letícia Pierini de Almeida,
  • Josiane Oliveira de Jesus,
  • Isaac Ferrari Del Favero,
  • Camila Cristina Giardi,
  • Lucas Caetano Dias Lourenço,
  • Nathalia Aparecida Reis Carneiro,
  • Laís Silva Sisconetto,
  • Lucy Clayton,
  • Marie-Pier Patton,
  • Lynne Moore,
  • Michael Verret,
  • Annemarie Docherty,
  • Gina Cranswick,
  • Debbie Alexander,
  • Gayle Beveridge,
  • Susan Begg,
  • Judy Coyle,
  • Annabel Giddings,
  • Guen Innes,
  • Michelle Steven,
  • Sophie Depierre,
  • Marielle Simon,
  • Marielle Simon,
  • Darell J. Triulzi,
  • Jonathan Cook,
  • Claude Hemphill

摘要

Purpose

In moderate-to-severe traumatic brain injury (TBI), anemia may exacerbate secondary cerebral injury, and patients with multiple trauma may be especially vulnerable to cerebral hypoxia. We conducted a secondary analysis of the HEMOTION trial (liberal transfusion strategy > 10 g/dL vs. restrictive > 7 g/dL), to assess whether multiple trauma modifies the effect of transfusion strategy after moderate-to-severe TBI.

Methods

We included all HEMOTION trial participants (n = 742) and defined multiple trauma using three definitions: (1) extracranial injury with Injury Severity Score (ISS) > 15; (2) extracranial injury requiring emergency extracranial surgery; (3) spinal injury with neurological deficit. The primary outcome was the 6-month Glasgow Outcome Scale Extended (GOS-E). We tested interactions between transfusion strategy and multiple trauma status using sliding dichotomy and hierarchical Poisson regression, with sensitivity analyses using classical dichotomy (GOS-E ≤ 4) and proportional odds models. Secondary outcomes included mortality, quality of life (EQ-5D-5L, QOLIBRI), functional independence (FIM), and depression (PHQ-9).

Results

We found no interaction between multiple trauma status and transfusion strategies on the 6-month GOS-E across all three definitions. The adjusted relative risk (RR) of an unfavourable outcome with the liberal strategy was 0.87 (95% CI 0.71–1.07) for patients with ISS > 15, 0.79 (0.59–1.05) for emergency extracranial surgery, and 0.99 (0.42–2.33) for spinal cord injury. Sensitivity analyses suggested a potential interaction for patients undergoing emergency extracranial surgery (p-interaction = 0.02 for proportional odds analysis; 0.05 for classical dichotomy). A liberal strategy was associated with better FIM, EQ-5D-5L, and Qolibri scores for definitions 1 and 2, but not 3, with no consistent interaction. Mortality and PHQ-9 did not differ.

Conclusion

Multiple trauma status was not associated with the effect of liberal vs. restrictive transfusion strategies on the GOS-E. Patients requiring emergency extracranial surgery may warrant further investigation.