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β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study.
Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden ; .
Department of Clinical Neuroscience, Karolinska Institutet, Solna, Stockholm, Sweden.
Orebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Solna, Stockholm, Sweden.
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2017 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: 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).

CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2017.
Keyword [en]
Beta-blocker, Functional outcome, Traumatic brain injury
National Category
Surgery Neurology
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-57380DOI: 10.1007/s00068-017-0779-5PubMedID: 28275834OAI: oai:DiVA.org:oru-57380DiVA: diva2:1093637
Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2017-05-08Bibliographically approved

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