Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study - 20/01/25

Doi : 10.1016/j.annemergmed.2024.07.014

Shu Utsumi, MD ^a,^⁎ , Shingo Ohki, MD, PhD ^a, Shunsuke Amagasa, MD, PhD ^c, Shinichiro Ohshimo, MD, PhD ^a, Nobuaki Shime, MD, PhD ^b

^a Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

^b Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Japan

^c Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan

^∗ Corresponding Author.

Abstract

Study objective

Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI).

Methods

We identified children aged <18 years with a severe TBI (Glasgow Coma Scale score less than 8) presenting to 1 of the 291 hospitals contributing to the Japanese Trauma Data Bank between 2019 and 2023. The primary outcome was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale (GOS) score of 1 to 3 at hospital discharge. Our primary exposure was any TXA administered in the hospital. Using propensity score-based inverse probability weighting, we used logistic regression to measure the association between TXA administration and death as well as poor neurologic outcome.

Results

Of the 342 included patients, 30 (14%) died, and 102/225 (45%) had a GOS score less than 4 at discharge. After inverse propensity weighting, TXA administration was not associated with either mortality (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.61 to 2.54) or poor neurologic outcome (aOR 0.86, 95% CI 0.47 to 1.56).

Conclusions

TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.

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Plan

Introduction

Background

Methods

Study Design, Setting, and Data Source

Selection of Patients

	Please see page 102 for the Editor’s Capsule Summary of this article.
	Supervising editor : Lise E. Nigrovic, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors .
	Author contributions: SU conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript, and takes final responsibility for manuscript. SO carried out the initial analyses and critically reviewed and revised the manuscript. SA and SO, and NS critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
	Data sharing statement: Data are available from the corresponding author on application to the Japanese Society of Traumatology.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/ ). This study was conducted without financial support. The authors have no conflict of interest relevant to this article to disclose.
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