Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury

Background: The comparison between a restrictive and a liberal transfusion strategy in terms of the outcomes for critically ill patients with traumatic brain injury remains ambiguous.Patients and Methods: This randomized clinical trial included 500 adults with moderate to severe traumatic brain injury and anemia. Participants were assigned to receive red blood cell transfusions relied on either a liberal strategy (initiating transfusions at a hemoglobin level of ≤10 g/dL) or a restrictive strategy (initiating transfusions at ≤7 g/dL).Results: In both groups, the median GCS motor score was 4 (1-5) with a majority of cases demonstrating 5 (localization) in both groups followed by 1 (no movement), then 6 (Obedience to commands). the worst-prognosis group (GOS-E score ≤3) was the most prevalent between groups the Restrictive group had a notably higher unfavorable outcome rate (81.8% vs. 75.9%). At 6 months, mortality was 26.8% in the liberal strategy group and 26.4% in the restrictive strategy group, with insignificant differences across the two groups. QOL assessments reveal that the Liberal treatment strategy scores greater across EuroQol, EQ-5D-5L, and Qolibri scales, with more patients experiencing moderate to severe depression in the Restrictive group. Liberal group received significantly more red-cell units than Restrictive.Conclusions: A liberal transfusion approach did not lower the risk of negative neurological outcomes at six months for critically ill individuals with anemia and traumatic brain injury.