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Background Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury (TBI). However, the choice of initial resuscitation fluid including the role of plasma is unclear for patients after isolated TBI. Methods We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated TBI. “Early plasma” was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and in-hospital survival. After testing for interaction, sub-group analysis was performed based on pattern of brain injury on initial head CT: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage (MIH). Results Of the 633 isolated TBI patients included, 178 (28%) who received early plasma were more severely injured, coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% versus 84%, p=0.08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.71 – 1.96). On subgroup analysis, multifocal intracranial hemorrhage (MIH) was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (OR 3.34, 95% CI 1.20 – 9.35). Conclusion Although early plasma transfusion was not associated with improved in-hospital survival for all isolated TBI patients, early plasma was associated with increased in-hospital survival in those with MIH.

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