Beta blockers in critically ill patients with traumatic brain injury: Results from a multicenter, prospective, observational American Association for the Surgery of Trauma study.

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 American Association for the Surgery of Trauma Clinical Trial Group conducted a multi-institutional, prospective, observational trial in which adult TBI patients who required intensive care unit admission were compared based on beta blocker administration.

RESULTS:

From January 2015 to January 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 years vs. 48.6 years, p < 0.001) and had higher head Abbreviated Injury Scale 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 (adjusted odds ratio, 0.35; p < 0.001), and propranolol was superior to other beta blockers (adjusted odds ratio, 0.51, p = 0.010). A Cox-regression model using a time-dependent variable demonstrated a survival benefit for patients receiving beta blockers (adjusted hazard ratio, 0.42, p < 0.001) and propranolol was superior to other beta blockers (adjusted hazard ratio, 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:

Therapeutic/care management, level III.

• Authors: Eric J Ley, Samuel D Leonard, Galinos Barmparas, Navpreet K Dhillon, Kenji Inaba, Ali Salim, Karen R OʼBosky, Danielle Tatum, Hooman Azmi, Chad G Ball, Paul T Engels, Julie A Dunn, Matthew M Carrick, Jonathan P Meizoso, Sarah Lombardo, Bryan A Cotton, Thomas J Schroeppel, Sandro Rizoli, David S J Chang, Luis Alejandro de León, Joao Rezende-Neto, Tomas Jacome, Jimmy Xiao, Gina Mallory, Krishnamurti Rao, Lars Widdel, Samuel Godin, Angela Coates, Leo Andrew Benedict, Raminder Nirula, Sanjeev Kaul, Tong Li, Beta Blockers TBI Study Group Collaborators
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 84 Issue 2 Pg. 234-244 (02 2018) ISSN: 2163-0763 [Electronic] United States
• PMID: 29251711 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (pharmacology)
• Aged
• Brain Injuries, Traumatic (complications, drug therapy, epidemiology)
• Canada (epidemiology)
• Critical Illness (therapy)
• Disease Management
• Female
• Humans
• Incidence
• Injury Severity Score
• Male
• Middle Aged
• Prospective Studies
• Societies, Medical
• Survival Rate (trends)
• Trauma Centers (statistics & numerical data)
• Traumatology
• United States (epidemiology)