Citation

Ley EJ, Leonard SD, Barmparas G, Dhillon NK, Inaba K, Salim A, OʼBosky KR, Tatum D, Azmi H, Ball CG, Engels PT, Dunn JA, Carrick MM, Meizoso JP, Lombardo S, Cotton BA, Schroeppel TJ, Rizoli S, Chang DSJ, de León LA, Rezende-Neto J, Jacome T, Xiao J, Mallory G, Rao K, Widdel L, Godin S, Coates A, Benedict LA, Nirula R, Kaul S, Li T. J. Trauma Acute Care Surg. 2018; 84(2): 234-244.

Affiliation

Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001747

PMID

29251711

Abstract

BACKGROUND: Beta blockers, a class of medications that inhibit endogenous catecholamines interaction with beta adrenergic receptors, are often administered to patients hospitalized after traumatic brain injury (TBI). We tested the hypothesis that beta blocker use after TBI is associated with lower mortality, and secondarily compared propranolol to other beta blockers.

METHODS: The AAST Clinical Trial Group conducted a multi-institutional, prospective, observational trial in which adult TBI patients who required ICU admission were compared based on beta blocker administration.

RESULTS: From 01/2015 to 01/2017, 2,252 patients were analyzed from 15 trauma centers in the United States and Canada with 49.7% receiving beta blockers. Most patients (56.3%) received the first beta blocker dose by hospital day 1. Those patients who received beta blockers were older (56.7 vs. 48.6 years, p < 0.001) and had higher head AIS scores (3.6 vs. 3.4, p<0.001). Similarities were noted when comparing sex, admission hypotension, mean Injury Severity Score, and mean Glasgow Coma Scale. Unadjusted mortality was lower for patients receiving beta blockers (13.8% vs. 17.7%, p = 0.013). Multivariable regression determined that beta blockers were associated with lower mortality (AOR 0.35; p < 0.001), and propranolol was superior to other beta blockers (AOR 0.51, p = 0.010). A Cox-regression model utilizing a time dependent variable demonstrated a survival benefit for patients receiving beta blockers (AHR: 0.42, p<0.001) and propranolol was superior to other beta blockers (AHR: 0.50, p=0.003).

CONCLUSION: Administration of beta blockers after TBI was associated with improved survival, before and after adjusting for the more severe injuries observed in the treatment cohort. This study provides a robust evaluation of the effects of beta blockers on TBI outcomes that supports the initiation of a multi-institutional randomized control trial. LEVEL OF EVIDENCE: Level III, Therapeutic/Care Management.

Language: en