{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:41:37Z","timestamp":1781833297292,"version":"3.54.5"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Blood transfusion therapy (BTT) is widely used in trauma patients. However, the adverse effects of BTT in pediatric trauma patients with traumatic brain injury (TBI) were poorly studied. The objective of this study is to evaluate the effect of BTT on mortality in children with severe TBI.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective cohort analysis, we analyzed 2012 and 2016 Kids\u2019 Inpatient Databases and used a weighted sample to obtain national outcome estimates. We included children aged 1 month to 21 years with TBI who were mechanically ventilated, considered severe TBI; we then compared the demographics, comorbidities, and mortality rates of those patients who had undergone BTT to those who did not. Statistical analysis was performed using the chi-squared test and regression models. In addition, in a correlative propensity score matched analysis, cases (BTT) were matched 1:1 with controls (non-BTT) based on age, gender, hospital region, income quartiles, race, and All Patients Refined Diagnosis Related Groups (APRDRG) severity of illness scores to minimize the effect of confounding variables between the groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 87,980 children with a diagnosis of TBI, 17,199 (19.5%) with severe TBI were included in the analysis. BTT was documented in 3184 (18.5%) children. Among BTT group, the mortality was higher compared to non-BTT group [31.6% (29.7\u201333.5%) vs. 14.4 (13.7\u201315.1%), (OR 2.2, 95% CI 1.9\u20132.6; p&lt;0.05)]. In the BTT group, infants and adolescents, white race, APRDRG severity of illness, cardiac arrest, platelet, and coagulation factor transfusions were associated with higher mortality. In a propensity-matched analysis, BTT associated with a higher risk of mortality (32.1% [30.1\u201334.2] vs. 17.4% [15.8\u201319.1], p&lt;0.05; OR: 2.2, 95% CI: 1.9\u20132.6).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In children with severe TBI, blood transfusion therapy is associated with higher mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0279709","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T18:31:50Z","timestamp":1673029910000},"page":"e0279709","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["The need for blood transfusion therapy is associated with increased mortality in children with traumatic brain injury"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-6988","authenticated-orcid":true,"given":"Madhuradhar","family":"Chegondi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose F.","family":"Hernandez Rivera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuad","family":"Alkhoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balagangadhar R.","family":"Totapally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"pone.0279709.ref001","doi-asserted-by":"crossref","first-page":"497509.e1","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review","volume":"91","author":"MC Dewan","year":"2016","journal-title":"World Neurosurg"},{"issue":"1","key":"pone.0279709.ref002","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/0883073814544363","article-title":"The Epidemiology of Traumatic Brain Injury in Children and Youths: A Review of Research Since 1990","volume":"31","author":"DJ Thurman","year":"2016","journal-title":"J Child Neurol"},{"key":"pone.0279709.ref003","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jsr.2019.12.013","article-title":"Traumatic brain injury mortality among U.S. children and adolescents ages 0-19years, 1999\u20132017","volume":"72","author":"P Cheng","year":"2020","journal-title":"J Safety Res"},{"issue":"2","key":"pone.0279709.ref004","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1542\/peds.2005-2588","article-title":"Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States","volume":"118","author":"AJ Schneier","year":"2006","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0279709.ref005","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/ACO.0000000000000566","article-title":"Transfusion practices in traumatic brain injury","volume":"31","author":"JM East","year":"2018","journal-title":"Curr Opin Anaesthesiol"},{"issue":"5","key":"pone.0279709.ref006","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/ACO.0000000000000754","article-title":"Transfusion in adults and children undergoing neurosurgery: the outcome evidence","volume":"32","author":"H Feng","year":"2019","journal-title":"Curr Opin Anaesthesiol"},{"issue":"3","key":"pone.0279709.ref007","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/PCC.0000000000001737","article-title":"Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies","volume":"20","author":"PM Kochanek","year":"2019","journal-title":"Pediatr Crit Care Med"},{"issue":"16","key":"pone.0279709.ref008","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa066240","article-title":"Transfusion strategies for patients in pediatric intensive care units","volume":"356","author":"J Lacroix","year":"2007","journal-title":"N Engl J Med"},{"issue":"10061","key":"pone.0279709.ref009","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1016\/S0140-6736(15)01313-6","article-title":"Transfusion reactions: prevention, diagnosis, and treatment","volume":"388","author":"M Delaney","year":"2016","journal-title":"Lancet"},{"key":"pone.0279709.ref010","unstructured":"HCUP Databases. 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A Systematic Comparison With Randomized Clinical Trials","volume":"43","author":"GD Kitsios","year":"2015","journal-title":"Crit Care Med"},{"issue":"3","key":"pone.0279709.ref014","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1213\/00000539-199809000-00006","article-title":"Predictive factors of outcome in severely traumatized children","volume":"87","author":"GA Orliaguet","year":"1998","journal-title":"Anesth Analg"},{"key":"pone.0279709.ref015","first-page":"6803860","article-title":"The Effect of Hemoglobin Levels on Mortality in Pediatric Patients with Severe Traumatic Brain Injury","volume":"2016","author":"KF Yee","year":"2016","journal-title":"Can Respir J"},{"issue":"4","key":"pone.0279709.ref016","doi-asserted-by":"crossref","first-page":"297301","DOI":"10.1159\/000446253","article-title":"Hemoglobin Threshold for Blood Transfusion in a Pediatric Intensive Care Unit","volume":"43","author":"M Chegondi","year":"2016","journal-title":"Transfus Med Hemother"},{"issue":"7","key":"pone.0279709.ref017","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1136\/adc.2004.062174","article-title":"A new formula for blood transfusion volume in the critically ill","volume":"90","author":"KP Morris","year":"2005","journal-title":"Arch Dis Child"},{"issue":"6","key":"pone.0279709.ref018","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.3390\/ijerph15061171","article-title":"Trend of Age-Adjusted Rates of Pediatric Traumatic Brain Injury in U.S. Emergency Departments from 2006 to 2013","volume":"15","author":"C Chen","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"pone.0279709.ref019","first-page":"1469","article-title":"Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool?","volume":"34","author":"PS Romano","year":"2000","journal-title":"Health Serv Res"},{"issue":"3","key":"pone.0279709.ref020","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s12028-015-0191-0","article-title":"Acute Traumatic Coagulopathy Accompanying Isolated Traumatic Brain Injury is Associated with Worse Long-Term Functional and Cognitive Outcomes","volume":"24","author":"PA Abdelmalik","year":"2016","journal-title":"Neurocrit Care"},{"issue":"4","key":"pone.0279709.ref021","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jamcollsurg.2016.12.046","article-title":"Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents","volume":"224","author":"IN Liras","year":"2017","journal-title":"J Am Coll Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279709","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T18:32:09Z","timestamp":1673029929000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279709"}},"subtitle":[],"editor":[{"given":"Alexander","family":"Wolf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,1,6]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0279709","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,6]]}}}