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The Effect of beta-blockade on Survival After Isolated Severe Traumatic Brain Injury
Orebro University Hospital. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital; Örebro University, Örebro, Sweden; Department of Surgery, Division of Acute Care Surgery and Trauma, Karolinska University Hospital Solna, Stockholm, Sweden.
Department of Surgery, Tartu University Hospital, Tartu, Estonia; Department of Surgery, North Estonia Medical Center, Tallinn, Estonia.
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
Orebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden.
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2015 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 39, no 8, 2076-2083 p.Article in journal (Refereed) Published
Abstract [en]

Several North American studies have observed survival benefit in patients exposed to beta-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of beta-blockade on mortality in a Swedish cohort of isolated severe TBI patients.

The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) a parts per thousand yen3 excluding extra-cranial injuries AIS a parts per thousand yen3. Multivariable logistic regression analysis was used to determine the effect of beta-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission beta-blocker versus not and the effect of specific type of beta-blocker on the overall outcome.

Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to beta-blockers during their hospital admission. The exposed patients were older (62 +/- A 16 years vs. 49 +/- A 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS a parts per thousand currency sign8: 32 % vs. 28 %, p = 0.007; ISS a parts per thousand yen16: 71 % vs. 59 %, p = 0.001; head AIS a parts per thousand yen4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive beta-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to beta-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95 % 2.7-8.5, p = 0.001). No difference in survival was noted in regards to the type of beta-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to beta-blockers compared to those on pre-admission beta-blocker therapy (AOR 3.0 CI 95 % 1.2-7.1, p = 0.015).

Beta-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission beta-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.

Place, publisher, year, edition, pages
2015. Vol. 39, no 8, 2076-2083 p.
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-45533DOI: 10.1007/s00268-015-3039-zISI: 000357690700032PubMedID: 25809062Scopus ID: 2-s2.0-84937643047OAI: oai:DiVA.org:oru-45533DiVA: diva2:845787
Available from: 2015-08-13 Created: 2015-08-12 Last updated: 2017-03-17Bibliographically approved

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Orebro University HospitalSchool of Health and Medical Sciences, Örebro University, SwedenSchool of Medicine, Örebro University, Sweden
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CiteExportLink to record
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