{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:07:57Z","timestamp":1786122477311,"version":"build-2736575974"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Calcium disturbances are common in patients with traumatic injuries, exacerbated by shock and blood product resuscitation. Recently, empiric calcium supplementation has been recommended with the first unit of blood transfusion, despite a lack of data supporting this practice. We hypothesize that there are risks associated with calcium administration in patients receiving small volume transfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective review of patients admitted to our Level 1 trauma center from 2018 to 2024 who received 1\u20133 units of red blood cells (RBCs). Patients were stratified by calcium levels and whether they received early calcium supplementation. A logistic regression was used to estimate odds ratios for the association between calcium levels, calcium supplementation, and outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury, myocardial infarction, acute respiratory distress syndrome, and venous thromboembolism. The model was adjusted for age, sex, ISS and shock index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2,680 patients were included. When stratified by calcium levels and supplementation status, patients were similar in terms of age, sex, mechanism and injury severity score, but shock index was higher among patients receiving calcium supplementation. After adjustment, hypocalcemic patients who received calcium supplementation had higher odds of developing acute kidney injury, acute respiratory distress syndrome, deep vein thrombosis, and pulmonary embolism (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In trauma patients who received 1\u20133 units of RBCs, early calcium supplementation was associated with adverse outcomes. The use of early, empiric calcium supplementation in conjunction with minimal transfusion should be carefully considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03282-6","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T10:29:30Z","timestamp":1786098570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early calcium replacement after minimal blood transfusion is associated with adverse outcomes"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4465-0784","authenticated-orcid":false,"given":"W. Preston","family":"Hewgley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell L.","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Baird","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain G.","family":"Hashmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha J.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan O.","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Kerby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Holcomb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rondi B.","family":"Gelbard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"3282_CR1","doi-asserted-by":"publisher","unstructured":"Wray JP, et al. 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Clinical protocol for damage-control resuscitation for the adult trauma patient. J Trauma Acute Care Surg. 2024 Mar 1;96(3):510-520. https:\/\/doi.org\/10.1097\/TA.0000000000004088.","DOI":"10.1097\/TA.0000000000004088"},{"key":"3282_CR10","doi-asserted-by":"publisher","unstructured":"Leech C, Clarke E. Pre-hospital blood products and calcium replacement protocols in UK critical care services: a survey of current practice. Resusc Plus. Sep 2022;11:100282. https:\/\/doi.org\/10.1016\/j.resplu.2022.100282.","DOI":"10.1016\/j.resplu.2022.100282"},{"key":"3282_CR11","doi-asserted-by":"publisher","unstructured":"Kronstedt S, et al. Hypocalcemia as a predictor of mortality and transfusion. A scoping review of hypocalcemia in trauma and hemostatic resuscitation. Transfusion. 2022 Aug;62(Suppl 1):S158-S166 https:\/\/doi.org\/10.1111\/trf.16965.","DOI":"10.1111\/trf.16965"},{"key":"3282_CR12","doi-asserted-by":"publisher","unstructured":"MacKay EJ, et al. 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Preston Hewgley is a consultant for Vericel Corporation. Jan Jansen has received grants from National Institutes of Health, the Department of Defense, the Medical Technology Enterprise Consortium, and the National Institute for Health Research. He is a consultant for CSL Behring, Cellphire, Octapharma, and Infrascan; and has received study support from CSL Behring, Infrascan, and RevMedX. Dr Holcomb is on the board of directors of QinFlow, Hemostatics, MiNK Therapeutics and Zibrio. He receives research grant support from the DoD, CSL and NIH, focused on hemorrhage control and resuscitation. He consults with Geneva Foundation, Aspen Medical, Infrascan, MGB, Obvius Robotics and is the co-inventor of the Junctional Emergency Tourniquet Tool and thus receive royalties from UT Health.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"238"}}