Tranexamic acid-based prediction model for blood transfusion in traumatic brain injury: A retrospective case-control study

Blood transfusion planning in traumatic brain injury (TBI) is ideal and pharmacotherapy such as tranexamic acid (TXA) may influence transfusion requirement. Within this retrospective, single-center case–control study, 259 TBI patients who were admitted from January 2022 to December 2024 were randomly allocated into training (70%) and validation (30%) datasets. Demographic, clinical, laboratory, surgical and pharmacologic variables-like TXA-were evaluated using univariable and multivariable logistic regression for independent predictors of transfusion. Surgery, tracheal intubation, longer hospital stay, lower hemoglobin and TXA administration were independent predictors of transfusion. The TXA nomogram had high discrimination (AUC 0.94 training; 0.93 validation), good calibration and clinical utility as demonstrated by decision curve analysis. Higher TXA use in transfused patients is likely due to confounding by indication, as patients were more ill and more likely to receive TXA. The inclusion of TXA in predictive models enhances personalized risk prediction of transfusion, but the model remains hypothesis-generating and requires external multicenter verification before being used clinically. This study is supportive of the development of pragmatic, pharmacology-driven tools for early risk stratification and precision transfusion planning in TBI.