title: Efficacy of beta-blockade after isolated blunt head injury: does race matter?
abstract: BACKGROUND
  Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity.
  
  
  METHODS
  The trauma registry and the surgical intensive care unit (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 2009. Patients sustaining major associated extracranial injuries (Abbreviated Injury Scale [AIS] score ≥ 3 in any body region) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcome evaluated was in-hospital mortality stratified by ethnicity.
  
  
  RESULTS
  During the 11-year study period, 3,750 patients were admitted to the Los Angeles County + University of Southern California Medical Center trauma ICU because of blunt trauma. Of these, 65% (n = 2,446) had an "isolated" head injury. When stratified by race, most patients were Hispanics (60%), followed by Whites (21%), Asians (11%), and African Americans (8%). After adjusting for confounding variables with multivariate regression, only those of Asian and Hispanic descent demonstrated significantly improved outcomes associated with beta-blocker administration.
  
  
  CONCLUSIONS
  Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.
authors.affiliation: Department of Surgery, Cedars Sinai Medical Center, 8635 West Third Street, Suite 650, Los Angeles, CA 90048, USA. bukurm@cshs.org
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
authors.forename: Shahin
authors.initials: S
authors.lastname: Mosheni
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Daniel
authors.initials: D
authors.lastname: Margulies
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D005260:Female; D016489:Head Injuries, Closed / Q000188:drug therapy*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D000319:Adrenergic beta-Antagonists