Liberal vs. restrictive transfusion strategies for acute brain injury: a systematic review and frequentist-Bayesian meta-analysis
An erratum to this article was published (Intensive Care Med, May 2025 ↗)
Authors' conclusion
This review did not provide definitive evidence of a neurological benefit from liberal transfusion strategies in acute brain injury.
Study context
- Population
- Adults with acute brain injury (TBI, SAH, intracranial hemorrhage) and GCS ≤ 13
- Participants
- 1,853 adults · 4 RCTs
- Comparison
- Liberal vs restrictive transfusion
- Liberaln = 922
- Restrictiven = 931reference
- Outcome
- Favorable neurological status
- Follow-up
- 180 days
Methodological detailstrial sequential analysis
- Trial sequential analysis
Pooled result
As reported in the abstract
Pooled frequentist RR for favorable neurological outcome
0.84
95% CI 0.65–1.09
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Favorable neurological outcome, low-risk-of-bias trials only (pre-specified sensitivity analysis)I2 = 0% · potential benefit in favor of the liberal strategy | 0.74 (0.63–0.87) | |
| 0.512Relative risk (log scale) |
Subgroups: TBI, initial GCS strata (subgroup)
- Consistent with the main findings
Bayesian analyses
- Estimated effect depended on assumptions and priors; unfavorable prior (from one trial with distinct protocol) less likely than neutral or favorable priors
Trial sequential analysis
- Current evidence insufficient to confirm a definitive effect
Secondary outcomes
- No significant difference between groups
Original publication
Liberal vs. restrictive transfusion strategies for acute brain injury: a systematic review and frequentist-Bayesian meta-analysis. Intensive Care Med. Published 17 February 2025. doi:10.
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