title: An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury.
abstract: A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and postinjury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate (P = 0.002) and multivariate analyses (P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Edavettal
authors.forename: Brian W
authors.initials: BW
authors.lastname: Gross
authors.forename: Katelyn
authors.initials: K
authors.lastname: Rittenhouse
authors.forename: James
authors.initials: J
authors.lastname: Alzate
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Lisa
authors.initials: L
authors.lastname: Estrella
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Miller
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
mesh_terms: D015998:Abbreviated Injury Scale; D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000070642:Brain Injuries, Traumatic / Q000401:mortality*; D004334:Drug Administration Schedule; D005260:Female; D015600:Glasgow Coma Scale; D006335:Heart Injuries / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists