1. Beta blockers in critically ill patients with traumatic brain injury: Results from a multicenter, prospective, observational American Association for the Surgery of Trauma study
- Author
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Godin S, Leo Andrew Benedict, Danielle Tatum, Raminder Nirula, Carrick Mm, Azmi H, Gina R. Mallory, Angela Coates, Chang Dsj, Inaba K, Li T, Rao K, Sarah Lombardo, Paul T. Engels, Chad G. Ball, Ali Salim, Xiao J, Joao B Rezende-Neto, Dunn Ja, Thomas Schroeppel, Widdel L, Jonathan P. Meizoso, Kaul S, Sandro Rizoli, Bryan A. Cotton, OʼBosky Kr, Galinos Barmparas, Dhillon Nk, Leonard Sd, Tomas Jacome, de León La, and Eric J. Ley
- Subjects
Male ,Canada ,medicine.medical_specialty ,Adrenergic receptor ,Traumatic brain injury ,medicine.drug_class ,Critical Illness ,Adrenergic beta-Antagonists ,Traumatology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Trauma Centers ,Brain Injuries, Traumatic ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Beta blocker ,Societies, Medical ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Disease Management ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,United States ,nervous system diseases ,Survival Rate ,nervous system ,Anesthesia ,Female ,Surgery ,Observational study ,business ,030217 neurology & neurosurgery - Abstract
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.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.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, p0.001) and had higher head Abbreviated Injury Scale scores (3.6 vs. 3.4, p0.001). 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; p0.001), 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, p0.001) and propranolol was superior to other beta blockers (adjusted hazard ratio, 0.50, p = 0.003).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.Therapeutic/care management, level III.
- Published
- 2018