title: Does Beta-Blockade Reduce the Risk of Depression in Patients with Isolated Severe Extracranial Injuries?
abstract: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.
  
  
  
  Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.
  
  
  
  Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).
  
  
  
  Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.
authors.affiliation: School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.|Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Ahl
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA, 90048, USA.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA, 90048, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.affiliation: School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.|Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Wallin
authors.affiliation: School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.|Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.affiliation: School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden. mohsenishahin@yahoo.com.|Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden. mohsenishahin@yahoo.com.|Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden. mohsenishahin@yahoo.com.
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003863:Depression / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control*
chemical_list: D000319:Adrenergic beta-Antagonists