Abstract
Abstract
Background
There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries.
Methods
Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS) ≥ 16 with Abbreviated Injury Score of ≤ 2 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar’s or paired Student’s t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications.
Results
698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt force trauma (88.5%) with a mean [standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, p < 0.001) as were cardiac complications (8.2% vs. 1.4%, p = 0.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, p = 0.690) or in-hospital complications.
Conclusions
Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine,Emergency Medicine
Reference34 articles.
1. Inaba K, Teixeira PG, David JS, Chan LS, Salim A, Brown C, et al. Beta-blockers in isolated blunt head injury. J Am Coll Surg. 2008;206(3):432–8.
2. Arbabi S, Campio EM, Hemmila MR, Barker M, Dimo M, Ahrns KS, et al. Beta-blocker use is associated with improved outcomes in adult trauma patients. J Trauma Acute Care Surg. 2007;62(1):56–61.
3. Mohseni S, Talving P, Thelin EP, Wallin G, Ljungqvist O, Riddez L. The effect of β-blockade on survival after isolated severe traumatic brain injury. J Trauma Acute Care Surg. 2015;76:804–8.
4. Mohseni S, Talving P, Wallin G, Ljungqvist O, Riddez L. Preinjury β-blockade is protective in isolated severe traumatic brain injury. World J Surg. 2014;76(3):804–8.
5. Cotton BA, Snodgrass KB, Fleming SB, Carpenter RO, Kemp CD, Arbogast PG, et al. Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma Acute Care Surg. 2007;62(1):26–33.