Impact of Beta-Blocker Use on Mortality Across Traumatic Brain Injury Severity: A Retrospective Cohort Study
Karen Berger, Brenda Echevarria Munoz, Stacey L. Tannenbaum, Lisaine Lopez-Borges, John BerneBackground/Objectives:
Traumatic brain injury (TBI) is a major cause of morbidity and mortality. The initial insult can lead to tissue and cellular damage that results in an excessive catecholamine release, which may be mitigated with beta-blockers (BB). However, guidelines recommend their use only under specific conditions. This study compared the use of BB to no BB use in patients with TBI at an urban trauma center.
Methods:
This was a retrospective chart review of all adult patients with TBI admitted to the intensive care unit (ICU). Patients who received at least 2 consecutive doses of any scheduled BB were compared with those who did not receive any BB. The primary outcome was in-hospital mortality. Secondary outcomes were the rate of 28-day mortality, in-hospital length of stay, ICU length of stay, and discharge disposition. Safety outcomes were bradycardia, hypotension, and use of vasopressors following BB administration. Subgroup analyses of propranolol, mild/moderate, and severe TBI populations were also evaluated.
Results:
A total of 1197 patients were included in the study, of whom 375 received BB and 822 did not. The majority of patients were male (71.1%) and had a mean age of 53.5 years. Propranolol (42.1%) was the most commonly ordered initial BB. There was no difference in the rate of in-hospital mortality between the BB and no-BB groups (13.1% vs. 11.9%;
Conclusions:
The use of BB in patients with severe TBI was associated with lower in-hospital mortality.