Citation

Mohseni S, Talving P, Thelin EP, Wallin G, Ljungqvist O, Riddez L. World J. Surg. 2015; 39(8): 2076-2083.

Affiliation

Department of Surgery, Division of Acute Care Surgery, Orebro University Hospital and Orebro University, 701 85, Orebro, Sweden, mohsenishahin@yahoo.com.

Copyright

(Copyright © 2015, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00268-015-3039-z

PMID

25809062

Abstract

BACKGROUND: Several North American studies have observed survival benefit in patients exposed to β-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of β-blockade on mortality in a Swedish cohort of isolated severe TBI patients.

METHODS: The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) ≥3 excluding extra-cranial injuries AIS ≥3. Multivariable logistic regression analysis was used to determine the effect of β-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission β-blocker versus not and the effect of specific type of β-blocker on the overall outcome.

RESULTS: Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to β-blockers during their hospital admission. The exposed patients were older (62 ± 16 years vs. 49 ± 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS ≤8: 32 % vs. 28 %, p = 0.007; ISS ≥16: 71 % vs. 59 %, p = 0.001; head AIS ≥4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive β-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to β-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95 % 2.7-8.5, p = 0.001). No difference in survival was noted in regards to the type of β-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to β-blockers compared to those on pre-admission β-blocker therapy (AOR 3.0 CI 95 % 1.2-7.1, p = 0.015).

CONCLUSIONS: β-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission β-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.

Language: en