Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial - Scorecard - MDSpire
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Comparative Analysis of Restrictive and Liberal Blood Transfusion Approaches in Patients with Traumatic Brain Injury: Insights from the TRAIN Trial

  • By

  • Irene Sbaraini Zernini

  • Chiara Faso

  • Carla Bittencourt Rynkowski

  • Kirsten Moller

  • Piet Lormans

  • Manuel Quintana Diaz

  • Anselmo Caricato

  • Marjorie Beumier

  • Evy Voets

  • Mario Arias

  • Herve Quintard

  • Diego Morocho

  • Pedro Kurtz

  • Erik Roman Pognuz

  • Olivier Huet

  • Ata Mahmoodpoor

  • Aaron Blandino-Ortiz

  • Sara Alcantara

  • Russell Chabanne

  • Francisco Cicho

  • Stan Popugaev

  • Angelo Giacomucci

  • Jamil Dibu

  • Raphael Cinotti

  • Pierre Bouzat

  • Jean-Louis Vincent

  • Elisa Gouvêa Bogossian

  • Fabio Silvio Taccone

  • TRAIN Study Trial Group

  • Claudia Díaz

  • Andrés Saravia

  • Ahmas Bayrlee

  • Laura Nedolast

  • Hussam Elkambergy

  • Haamid Siddique

  • Jihad Mallat

  • Nahla AlJaberi

  • Samer Shoshan

  • Ayo Mandi

  • Bruno De Oliveira

  • Malligere Prasanna

  • Rehan Haque

  • Dnyaneshwar Munde

  • Sara Chaffee

  • Fatma Alawadhi

  • Eija Junttila

  • Teemu Luoto

  • Simona Šteblaj

  • Jacques Creteur

  • Dominique Durand

  • Caroline Abbenhuijs

  • Nancy Itesa Matumikina

  • Filippo Annoni

  • Leda Nobile

  • Miguel Ulloa Bersatti

  • Igor Yovenko

  • Alexander Tsarev

  • Jasperina Dubois

  • Luc Janssen

  • Luigi Zattera

  • Leire Pedrosa

  • Berta Monleon Lopez

  • Ainhoa Serrano

  • Nekane Romero-García

  • Xavier Wittebole

  • Antonio M Dell'Anna

  • Camilla Gelormini

  • Eleonora Stival

  • Pilar Marcos Neira

  • Regina Roig Pineda

  • Lara Bielsa Berrocal

  • Maite Misis del Campo

  • Stepani Bendel

  • Jorge H Mejía-Mantilla

  • Ángela Marulanda

  • Wojciech Dabrowski

  • Rune Damgaard Nielsen

  • Markus Harboe Olsen

  • Helene Ravnholt Jensen

  • Ida Møller Larsen

  • Roberta Tallarico

  • Umberto Lucangelo

  • Maria Isabel Gonzales Perez

  • Carole Ichai

  • Karim Asenhoune

  • Karim Lakhal

  • Charlotte Fernandez-Canal

  • Samuel Gay

  • Marie Lebouc

  • David Bougon

  • Etienne Escudier

  • Michel Sirodot

  • Albrice Levrat

  • Alix Courouau

  • Jacques Duranteau

  • Aurore Rodrigues

  • Naima Makouche

  • Gilles Francony

  • Olivier Vincent

  • Perrine Boucheix

  • Clotilde Schilte

  • Anais Adolle

  • Thomas Gargadennec

  • Patricia Dias

  • Gwenaelle Desanglois

  • Alexia Meheut

  • Pauline Cam

  • Geert Meyfroidt

  • Liese Mebis

  • Alexandra Hendrickx

  • Pieetr Wouters

  • Sylvia Van Hulle

  • Alain D'Hondt

  • Marc Burgeois

  • Olivier Simonet

  • Frederic Vallot

  • Pablo Centeno

  • Matias Anchorena

  • Ximena Benavente

  • Maximilian D'Onofrio

  • Nydia Funes

  • Antonio Barra de Oca

  • Gabriela Izzo

  • Charlotte Castelain

  • Filippo Soetens

  • Manuel Jabaja

  • Diego Tutillo

  • Celeste Dias

  • Elena Perez Solada

  • Pilar Justo

  • Amparo Lopez Gomez

  • Francisco Chico

  • Maria Fernanda Garcia

  • Fabricio Picoita

  • Stela Velasco Eichler

  • Gabriela Nonticuri Bianchi

  • João Pedro Britz

  • Jaqueline Almeida Pimentel

  • Mário Sérgio Fernandes

  • Hedi Gharsallah

  • Zied Hajjej

  • Walid Samoud

  • Oleg Grebenchikov

  • Valery Likhvantsev

  • Elena Stroiteleva

  • Nikolaos Markou

  • Dimitra Bakali

  • Dionysia Koutrafouri

  • Ahmed Subhy Alsheikhly

  • Sara Maccherani

  • Janneke Horn

  • Mohamed Elbahnasawy

  • Arezoo Ahmadi

  • Lien Decaesteker

  • Daphne Decruyenaere

  • Ruth Demeersseman

  • Yves Devriendt

  • Karen Embo

  • Ditty van Duijn

  • Patricia Ormskerk

  • Melanie Glasbergen-van Beijeren

  • Hassane Njimi

  • Alain Cariou

  • Christophe Lelubre

  • Giuseppe Ristagno

  • Nino Stocchetti

  • Mauro Oddo

  • Cathy De Deyne

  • Giuseppe Citerio

  • September 8, 2026

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Clinical Scorecard: Comparative Analysis of Restrictive and Liberal Blood Transfusion Approaches in Patients with Traumatic Brain Injury: Insights from the TRAIN Trial

At a Glance

CategoryDetail
ConditionTraumatic Brain Injury (TBI)
Key MechanismsImpaired cerebral autoregulation and anemia leading to tissue hypoxia.
Target PopulationAdults aged 18 years or older with acute brain injury and GCS score of 13 or less.
Care SettingIntensive Care Unit (ICU)

Key Highlights

  • Approximately 50% of TBI patients have anemia defined as Hb <9 g/dL.
  • Liberal transfusion strategy (Hb <9 g/dL) may lower unfavorable neurological outcomes compared to restrictive strategy (Hb <7 g/dL).
  • The TRAIN trial involved 72 ICUs across 22 countries.
  • Primary outcome assessed was unfavorable neurological outcome using GOS-E at 180 days.
  • Serious adverse events and organ failure incidence were evaluated within 28 days.

Guideline-Based Recommendations

Diagnosis

  • Assess hemoglobin levels and neurological status using GCS.

Management

  • Consider liberal transfusion strategy for patients with TBI and Hb <9 g/dL.

Monitoring & Follow-up

  • Monitor daily Hb levels, GCS, and SOFA scores.

Risks

  • Be aware of risks associated with red blood cell transfusion, including transfusion-related acute lung injury and sepsis.

Patient & Prescribing Data

Adults with moderate to severe TBI requiring ICU admission.

Transfusion strategies should be tailored based on hemoglobin levels and neurological outcomes.

Clinical Best Practices

  • Utilize a structured approach for assessing neurological outcomes post-transfusion.
  • Incorporate regular monitoring of hemoglobin and GCS in TBI patients.

Related Resources & Content

Original Source(s)

Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial

  • by Irene Sbaraini Zernini, Chiara Faso, Carla Bittencourt Rynkowski, Kirsten Moller, Piet Lormans, Manuel Quintana Diaz, Anselmo Caricato, Marjorie Beumier, Evy Voets, Mario Arias, Herve Quintard, Diego Morocho, Pedro Kurtz, Erik Roman Pognuz, Olivier Huet, Ata Mahmoodpoor, Aaron Blandino-Ortiz, Sara Alcantara, Russell Chabanne, Francisco Cicho, Stan Popugaev, Angelo Giacomucci, Jamil Dibu, Raphael Cinotti, Pierre Bouzat, Jean-Louis Vincent, Elisa Gouvêa Bogossian, Fabio Silvio Taccone, TRAIN Study Trial Group, Claudia Díaz, Andrés Saravia, Ahmas Bayrlee, Laura Nedolast, Hussam Elkambergy, Haamid Siddique, Jihad Mallat, Nahla AlJaberi, Samer Shoshan, Ayo Mandi, Bruno De Oliveira, Malligere Prasanna, Rehan Haque, Dnyaneshwar Munde, Sara Chaffee, Fatma Alawadhi, Eija Junttila, Teemu Luoto, Simona Šteblaj, Jacques Creteur, Dominique Durand, Caroline Abbenhuijs, Nancy Itesa Matumikina, Filippo Annoni, Leda Nobile, Miguel Ulloa Bersatti, Igor Yovenko, Alexander Tsarev, Jasperina Dubois, Luc Janssen, Luigi Zattera, Leire Pedrosa, Berta Monleon Lopez, Ainhoa Serrano, Nekane Romero-García, Xavier Wittebole, Antonio M Dell'Anna, Camilla Gelormini, Eleonora Stival, Pilar Marcos Neira, Regina Roig Pineda, Lara Bielsa Berrocal, Maite Misis del Campo, Stepani Bendel, Jorge H Mejía-Mantilla, Ángela Marulanda, Wojciech Dabrowski, Rune Damgaard Nielsen, Markus Harboe Olsen, Helene Ravnholt Jensen, Ida Møller Larsen, Roberta Tallarico, Umberto Lucangelo, Maria Isabel Gonzales Perez, Carole Ichai, Karim Asenhoune, Karim Lakhal, Charlotte Fernandez-Canal, Samuel Gay, Marie Lebouc, David Bougon, Etienne Escudier, Michel Sirodot, Albrice Levrat, Alix Courouau, Jacques Duranteau, Aurore Rodrigues, Naima Makouche, Gilles Francony, Olivier Vincent, Perrine Boucheix, Clotilde Schilte, Anais Adolle, Thomas Gargadennec, Patricia Dias, Gwenaelle Desanglois, Alexia Meheut, Pauline Cam, Geert Meyfroidt, Liese Mebis, Alexandra Hendrickx, Pieetr Wouters, Sylvia Van Hulle, Alain D'Hondt, Marc Burgeois, Olivier Simonet, Frederic Vallot, Pablo Centeno, Matias Anchorena, Ximena Benavente, Maximilian D'Onofrio, Nydia Funes, Antonio Barra de Oca, Gabriela Izzo, Charlotte Castelain, Filippo Soetens, Manuel Jabaja, Diego Tutillo, Celeste Dias, Elena Perez Solada, Pilar Justo, Amparo Lopez Gomez, Francisco Chico, Maria Fernanda Garcia, Fabricio Picoita, Stela Velasco Eichler, Gabriela Nonticuri Bianchi, João Pedro Britz, Jaqueline Almeida Pimentel, Mário Sérgio Fernandes, Hedi Gharsallah, Zied Hajjej, Walid Samoud, Oleg Grebenchikov, Valery Likhvantsev, Elena Stroiteleva, Nikolaos Markou, Dimitra Bakali, Dionysia Koutrafouri, Ahmed Subhy Alsheikhly, Sara Maccherani, Janneke Horn, Mohamed Elbahnasawy, Arezoo Ahmadi, Lien Decaesteker, Daphne Decruyenaere, Ruth Demeersseman, Yves Devriendt, Karen Embo, Ditty van Duijn, Patricia Ormskerk, Melanie Glasbergen-van Beijeren, Hassane Njimi, Alain Cariou, Christophe Lelubre, Giuseppe Ristagno, Nino Stocchetti, Mauro Oddo, Cathy De Deyne, Giuseppe Citerio

  • September 8, 2026

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