To the Editor There are concerns about study selection and data extraction in the meta-analysis by Dr Rohde and colleagues,1 which demonstrated an association between a restrictive red blood cell transfusion strategy compared with a liberal transfusion strategy and the risk of serious nosocomial infections (risk ratio [RR], 0.82 [95% CI, 0.72-0.95]) and infections after orthopedic surgery (RR, 0.70 [95% CI, 0.54-0.91]). The study by Karam et al,2 which was included in the meta-analysis for assessment of the association of transfusion strategy and the risk of serious infections, is a subgroup analysis of stable, critically ill children enrolled in a randomized trial, Transfusion Requirements in the Pediatric Intensive Care Unit (TRIPICU) study,3 which compared a hemoglobin threshold of 7 g/dL with a threshold of 9.5 g/dL. As seen in Figure 2 in the article, the TRIPICU study was also included in the meta-analysis, so these data were included twice.
Fujita T. Red Blood Cell Transfusion Strategies and Health Care–Associated Infection. JAMA. 2014;312(19):2041-2042. doi:10.1001/jama.2014.12313