Neuroanaesthesia & neurocritical care
Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial
Primary resultResult — go to the resultRelative risk 0.86 95% CI 0.75–1.00Authors' conclusion
In this secondary analysis of a multicenter randomized clinical trial, a liberal RBCT strategy was associated with a lower risk than a restrictive RBCT strategy of unfavorable neurological outcome at 180 days among patients with TBI.
Study context
- Population
- ICU patients with traumatic brain injury (TBI) and anaemia475 in primary analysis
- Participants
- 486 patients
- Comparison
- Liberal vs restrictive RBC transfusion strategy
- Liberaln = 236
- Restrictiven = 239reference
- Primary endpoint
- Unfavorable neurological outcome (Glasgow Outcome Scale Extended score 1 to 5)
- Follow-up
- 180 days
Methodological detailspreplanned, multicentre, 72 ICUs in 22 countries, ITT and per-protocol analyses
- Preplanned
- Multicentre
- 72 ICUs in 22 countries
- ITT and per-protocol analyses
Primary result
As reported in the abstract
Relative risk
0.86
95% CI 0.75–1.00
P = 0.047
Events by treatment group
Liberal vs Restrictive
RR 0.86 (95% CI 0.75–1.00); P = 0.047
Secondary outcomes
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Unfavorable neurological outcome, adjusted for confoundersAdjusted for several confounders | 0.60 (0.38–0.94) | P = 0.03 | |
| 0.20.5125Odds ratio (log scale) |
28-day mortality
- 28-day mortality RR
- 0.84 (95% CI 0.58-1.21; P = .34)
- No significant difference in secondary outcomes; 28-day mortality 42 of 240 [17.5%] vs 51 of 244 [20.9%]
Safety
Infection (serious adverse event)
- No significant difference in serious adverse events; infection RR
- 1.13 (95% CI 0.88-1.43; P = .34)
Cerebral ischemia (serious adverse event)
- No significant difference in serious adverse events; cerebral ischemia RR
- 0.87 (95% CI 0.40-1.90; P = .72)
Original publication
Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial. JAMA Netw Open. Published 1 September 2026. doi:10.
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