Beta-blockers in isolated blunt head injury.
BACKGROUND
The purpose of this study was to evaluate the effect of beta-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that beta-blocker exposure is associated with improved survival.


METHODS
The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score > or = 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality.


RESULTS
During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received beta-blockers and 953 (82%) did not. Patients receiving beta-blockers were older (50 +/- 21 years versus 38 +/- 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score > or = 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale < or = 8 less often (37% versus 47%, p = 0.01), more skull fractures (20% versus 12%, p < 0.01), and underwent craniectomy more frequently (23% versus 4%, p < 0.001). Stepwise logistic regression identified beta-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95% CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score > or = 4) had a mortality of 28% on beta-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p = 0.001).


CONCLUSIONS
Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with beta-blockade.
Inaba
Kenji
K
Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA.
Teixeira
Pedro G R
PG
David
Jean-Stephane
JS
Chan
Linda S
LS
Salim
Ali
A
Brown
Carlos
C
Browder
Timothy
T
Beale
Elizabeth
E
Rhee
Peter
P
Demetriades
Demetrios
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D016208:Databases, Factual; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists