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Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial
Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Karolinska University Hospital,Stockholm, Sweden; .
Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Örebro University, School of Medical Sciences. Department of Surgery.
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2020 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.

Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.

Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).

Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.

Level of evidence: Level II; therapeutic.

Study type: Therapeutic study.

Place, publisher, year, edition, pages
Springer, 2020.
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-79883DOI: 10.1007/s00268-020-05391-8ISI: 000510269300001PubMedID: 32002583OAI: oai:DiVA.org:oru-79883DiVA, id: diva2:1393052
Note

Funding Agency:

Research department of Shiraz University of Medical Sciences  1396-01-3814792

Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-02-14Bibliographically approved

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Ahl, RebeckaSjölin, GabrielCao, YangMohseni, Shahin

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