Whole-Blood vs Component Therapy in Adult Trauma: An Updated Systematic Review and Meta-Analysis
An erratum to this article was published (JAMA Surg, 1 May 2026 ↗)
Pooled result · 24-hour mortalityResult — go to the resultOdds ratio 0.76 95% CI 0.60–0.95Authors' conclusion
In this updated systematic review and meta-analysis, whole-blood transfusion was associated with reduced mortality in civilian but not military adult trauma patients, although the wide 95% PIs suggest substantial heterogeneity, indicating that benefits may vary considerably across settings.
Study context
- Population
- Adults (aged ≥16 years) with traumatic hemorrhage40 studies (2 RCTs, 38 cohort)
- Participants
- 49,776 adults
- Comparison
- Whole-blood vs component therapy
- Outcome
- Mortality
- Follow-up
- 24 hours
Methodological detailsupdated, random-effects (restricted maximum likelihood, Hartung-Knapp adjustment), prespecified analysis by civilian vs military settings, Risk of bias: Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) (observational), RoB 2 (RCTs), Searched MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, January 1, 2006 to June 30, 2025
- Updated
- Random-effects (restricted maximum likelihood, Hartung-Knapp adjustment)
- Prespecified analysis by civilian vs military settings
- Risk of bias: ROBINS-I (observational), RoB 2 (RCTs)
- Searched MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, January 1, 2006 to June 30, 2025
Pooled result
24-hour mortality
Odds ratio
0.76
95% CI 0.60–0.95
Whole blood vs Component therapy
OR 0.76 (95% CI 0.60–0.95)
As reported in the abstract
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| 24-h mortality, civilians (subgroup; 24 studies; n = 39 028) · τ2 = 0.27; I2 = 89%; 95% PI, 0.28-1.91 · prespecified analysis by setting | 0.73 (0.57–0.93) | |
| 30-day mortality, civilians (subgroup) | 0.76 (0.60–0.98) | |
| 0.512Odds ratio (log scale) |
| Outcome | Mean difference (units) (95% CI) | |
|---|---|---|
| Transfusion requirements, civilians (subgroup) | −2.66 (−3.96 to −1.35) | |
| −4−202Difference, units (linear scale) |
- 24-h mortality, civilians (subgroup; 24 studies; n = 39 028) — Absolute risk reduction (based on median control mortality of 20% [range, 15%-25%]); 95% CI, 1.4-8.6 percentage points
- 4.6 percentage points
24-h mortality, military settings (subgroup; 5 studies; n = 2171)
- No benefit observed in military settings
- OR 0.99 (95% CI 0.58-1.70)
- Prespecified analysis by setting
Original publication
Whole-Blood vs Component Therapy in Adult Trauma: An Updated Systematic Review and Meta-Analysis. JAMA Surg. Published 1 May 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →