title: β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study.
abstract: OBJECTIVE
  Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.
  
  
  METHODS
  Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.
  
  
  RESULTS
  362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).
  
  
  CONCLUSIONS
  Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.|School of Medical Sciences, Orebro University, Orebro, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Ahl
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Solna, 17176, Stockholm, Sweden.
authors.forename: E P
authors.initials: EP
authors.lastname: Thelin
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Sjölin
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Solna, 17176, Stockholm, Sweden.
authors.forename: B-M
authors.initials: BM
authors.lastname: Bellander
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Riddez
authors.affiliation: Department of Surgery, Tartu University Hospital, Puusepa 8, Tartu, 50406, Estonia.
authors.forename: P
authors.initials: P
authors.lastname: Talving
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden. mohsenishahin@yahoo.com.|Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden. mohsenishahin@yahoo.com.|School of Medical Sciences, Orebro University, Orebro, Sweden. mohsenishahin@yahoo.com.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-7097-487X
authors.initials: S
authors.lastname: Mohseni
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy* / Q000401:mortality / Q000534:rehabilitation; D016022:Case-Control Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D016019:Survival Analysis; D013548:Sweden
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blocker; Functional outcome; Traumatic brain injury