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Beta Blockers in Critically Ill Patients with Traumatic Brain Injury: Results from a Multicenter, Prospective, Observational American Association for the Surgery of Trauma Study
Ley EJ, Leonard SD, Barmparas G, et al. J Trauma Acute Care Surg. 2018;84:234- 44.
Study Question: Is beta blocker use after traumatic brain injury (TBI) associated with lower mortality?
Study Description: This trial was conducted at 15 trauma centers in the United States and Canada from January 2015 to January 2017. Adults with blunt TBI who required intensive care unit admission were included. Patients who expired in the emergency department were excluded. Beta blockers were used at the discretion of the attending physician. The primary outcome was 30-day mortality. Secondary outcomes included neurological function at discharge and hospital length of stay (LOS). Patients who received any beta blocker during admission were compared to those who did not. A subgroup analysis compared propranolol to all other beta blockers.
Results: A total of 2252 patients were included with 49.7% receiving beta blockers; these patients were significantly older, more likely to be on anticoagulants, admitted for falls, intubated in the ED, and had a higher head abbreviated injury scale score. Labetalol IV was the most common beta blocker administered. 30-day mortality was significantly lower in the beta blocker group (13.8% vs. 17.7%, p = 0.013). Patients in the non-beta blocker group had more favorable neurological outcomes at discharge (73% vs. 65%, p < 0.01); however, this difference was not significant after adjusting for confounders. Hospital LOS was significantly higher in the beta blocker group before and after adjusting for confounders. 30-day mortality was significantly lower in the propranolol cohort (9.3% vs. 15.9%, p = 0.003).
Conclusion(s): Beta blocker use after TBI is associated with lower mortality. Propranolol was associated with lower mortality than other beta blockers.
Perspective: Bradycardia and hypotension after TBI are associated with increased mortality. Therefore the use of beta blockers should be considered in the context of each patient's unique clinical scenario. Because of variances in TBI management and beta blocker use across the 15 trauma centers studied, it is difficult to determine optimal dosing and timing of beta blocker administration in this population.