Plasma transfusion and hospital mortality in moderate-severe traumatic brain injury

Background: Prior research suggests that plasma may improve outcomes in traumatic brain injury (TBI). We examined the association between plasma administration and mortality in moderate-severe TBI in a large retrospective cohort, hypothesizing plasma is associated with decreased mortality after accounting for confounding covariates. Materials and Methods: Patients from the 2017-2020 Trauma Quality Improvement Program (TQIP) dataset >= 18 years with moderate-severe TBI were included. We excluded patients with comorbidities associated with bleeding or sensitivity to volume (antiplatelet or anticoagulation medications, bleeding disorders, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease). Multivariable logistic regression examined the association between plasma volume transfused in the first four hours and hospital mortality, adjusting for sociodemographics, severity of injury/illness, neurologic status, and volume of other blood products. We also adjusted for and included interactions with hemorrhage markers (shock; need for hemorrhage control). Results: Of 63,918 patients included, hospital mortality was 37.0 %. 82.8 % received no plasma. Each unit of plasma was associated with greater unadjusted mortality, with odds ratio (OR): 1.13 (95 % confidence interval: 1.12-1.14), but after confounder adjustment, plasma units were not associated with greater mortality, with OR: 1.01 (0.99-1.03). While the overall adjusted effect of plasma was not significant, significant interactions between hemorrhage markers and plasma were present (p < 0.001). Conclusions: Administration of plasma within the first four hours after hospital presentation was not associated with decreased or increased mortality in adult patients with moderate to severe TBI after confounder adjustment. Interaction analysis suggests the presence of hemorrhage improves the effect of plasma on mortality in TBI. This important clinical question should be answered with a prospective randomized study of plasma for nonbleeding patients with TBI.