title: The Effect of β-blockade on Survival After Isolated Severe Traumatic Brain Injury.
abstract: BACKGROUND
  Several North American studies have observed survival benefit in patients exposed to β-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of β-blockade on mortality in a Swedish cohort of isolated severe TBI patients.
  
  
  METHODS
  The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS)≥3 excluding extra-cranial injuries AIS≥3. Multivariable logistic regression analysis was used to determine the effect of β-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission β-blocker versus not and the effect of specific type of β-blocker on the overall outcome.
  
  
  RESULTS
  Overall, 874 patients met the study criteria. Of these, 33% (n=287) were exposed to β-blockers during their hospital admission. The exposed patients were older (62±16 years vs. 49±21 years, p<0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS≤8: 32% vs. 28%, p=0.007; ISS≥16: 71% vs. 59%, p=0.001; head AIS≥4: 60% vs. 45%, p<0.001). The crude mortality was higher in patients who did not receive β-blockers (17% vs. 11%, p=0.007) during their admission. After adjustment for significant confounders, the patients not exposed to β-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95% 2.7-8.5, p=0.001). No difference in survival was noted in regards to the type of β-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to β-blockers compared to those on pre-admission β-blocker therapy (AOR 3.0 CI 95% 1.2-7.1, p=0.015).
  
  
  CONCLUSIONS
  β-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission β-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.
authors: Department of Surgery, Division of Acute Care Surgery, Orebro University Hospital and Orebro University, 701 85, Orebro, Sweden, mohsenishahin@yahoo.com.
authors: Shahin
authors: S
authors: Mohseni
authors: Peep
authors: P
authors: Talving
authors: Eric P
authors: EP
authors: Thelin
authors: Göran
authors: G
authors: Wallin
authors: Olle
authors: O
authors: Ljungqvist
authors: Louis
authors: L
authors: Riddez
mesh_terms: D015998:Abbreviated Injury Scale; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000401:mortality / Q000628:therapy; D006408:Hematoma, Subdural / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065840:Protective Factors; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy; D013548:Sweden; D014193:Trauma Centers; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists