Ley EJ, et al. - In this study, researchers investigated if beta blocker use after traumatic brain injury (TBI) was associated with lower mortality. They also compared propranolol to other beta blockers. Before and after adjusting for the more severe injuries observed in the treatment cohort, beta-blocker administration after TBI was associated with improved survival. Findings provide a robust evaluation of the effects of beta blockers on TBI outcomes.

Methods

• A multi-institutional, prospective, observational trial was performed by the American Association for the Surgery of Trauma Clinical Trial Group.
• Based on beta blocker administration, adult TBI patients who required intensive care unit admission were compared.

Results

• From 15 trauma centers in the United States and Canada, 2,252 patients were analyzed from January 2015 to January 2017.
• Of these, 49.7% were receiving beta blockers.
• By hospital day 1, most patients (56.3%) received the first beta blocker dose.
• Researchers noticed that patients receiving 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).
• When comparing sex, admission hypotension, mean Injury Severity Score, and mean Glasgow Coma Scale , similarities were noted.
• For patients receiving beta blockers, lower unadjusted mortality was observed (13.8% vs 17.7%, p=0.013).
• In multivariable regression, beta blockers were found to be 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 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) were demonstrated in Cox-regression model using a time-dependent variable.