• Shu Utsumi, Shingo Ohki, Shunsuke Amagasa, Shinichiro Ohshimo, and Nobuaki Shime.
• Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: shu8109@gmail.com.
• Ann Emerg Med. 2024 Oct 1.

Study ObjectiveTranexamic 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).MethodsWe 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 outcomes was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale 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.ResultsOf the 342 included patients, 30 (14%) died, and 102 (45%) had a GCS score less than 8 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).ConclusionsTXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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