Beta-Blockers in Isolated Blunt Head Injury

Kenji Inaba, Pedro G R Teixeira, Jean Stephane David, Linda S. Chan, Ali Salim, Carlos Brown, Timothy Browder, Elizabeth Beale, Peter Rhee, Demetrios Demetriades

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background: The purpose of this study was to evaluate the effect of β-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that β-blocker exposure is associated with improved survival. Study Design: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score ≥ 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and β-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality. Results: During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received β-blockers and 953 (82%) did not. Patients receiving β-blockers were older (50 ± 21 years versus 38 ± 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score ≥ 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale ≤ 8 less often (37% versus 47%, p = 0.01), more skull fractures (20% versus 12%, p < 0.01), and underwent craniectomy more frequently (23% versus 4%, p < 0.001). Stepwise logistic regression identified β-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95% CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score ≥ 4) had a mortality of 28% on β-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p = 0.001). Conclusions: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with β-blockade.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalJournal of the American College of Surgeons
Volume206
Issue number3
DOIs
StatePublished - Mar 2008

Fingerprint

Closed Head Injuries
Craniocerebral Trauma
Wounds and Injuries
Mortality
Odds Ratio
Skull Fractures
Body Regions
Glasgow Coma Scale
Injury Severity Score
Survival
Trauma Centers
Hospital Mortality
Brain Injuries
Registries
Logistic Models
Head
Demography
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Inaba, K., Teixeira, P. G. R., David, J. S., Chan, L. S., Salim, A., Brown, C., ... Demetriades, D. (2008). Beta-Blockers in Isolated Blunt Head Injury. Journal of the American College of Surgeons, 206(3), 432-438. https://doi.org/10.1016/j.jamcollsurg.2007.10.005

Beta-Blockers in Isolated Blunt Head Injury. / Inaba, Kenji; Teixeira, Pedro G R; David, Jean Stephane; Chan, Linda S.; Salim, Ali; Brown, Carlos; Browder, Timothy; Beale, Elizabeth; Rhee, Peter; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 206, No. 3, 03.2008, p. 432-438.

Research output: Contribution to journalArticle

Inaba, K, Teixeira, PGR, David, JS, Chan, LS, Salim, A, Brown, C, Browder, T, Beale, E, Rhee, P & Demetriades, D 2008, 'Beta-Blockers in Isolated Blunt Head Injury', Journal of the American College of Surgeons, vol. 206, no. 3, pp. 432-438. https://doi.org/10.1016/j.jamcollsurg.2007.10.005
Inaba K, Teixeira PGR, David JS, Chan LS, Salim A, Brown C et al. Beta-Blockers in Isolated Blunt Head Injury. Journal of the American College of Surgeons. 2008 Mar;206(3):432-438. https://doi.org/10.1016/j.jamcollsurg.2007.10.005
Inaba, Kenji ; Teixeira, Pedro G R ; David, Jean Stephane ; Chan, Linda S. ; Salim, Ali ; Brown, Carlos ; Browder, Timothy ; Beale, Elizabeth ; Rhee, Peter ; Demetriades, Demetrios. / Beta-Blockers in Isolated Blunt Head Injury. In: Journal of the American College of Surgeons. 2008 ; Vol. 206, No. 3. pp. 432-438.
@article{914591f2089e4ec48cca6f573705d461,
title = "Beta-Blockers in Isolated Blunt Head Injury",
abstract = "Background: The purpose of this study was to evaluate the effect of β-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that β-blocker exposure is associated with improved survival. Study Design: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score ≥ 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and β-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality. Results: During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18{\%}) received β-blockers and 953 (82{\%}) did not. Patients receiving β-blockers were older (50 ± 21 years versus 38 ± 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score ≥ 4) head injury (54{\%} versus 43{\%}, p < 0.01), Glasgow Coma Scale ≤ 8 less often (37{\%} versus 47{\%}, p = 0.01), more skull fractures (20{\%} versus 12{\%}, p < 0.01), and underwent craniectomy more frequently (23{\%} versus 4{\%}, p < 0.001). Stepwise logistic regression identified β-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95{\%} CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score ≥ 4) had a mortality of 28{\%} on β-blockers as compared with 60{\%} when they did not receive them (odds ratio: 0.3; 96{\%} CI, 0.1 to 0.6; p = 0.001). Conclusions: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with β-blockade.",
author = "Kenji Inaba and Teixeira, {Pedro G R} and David, {Jean Stephane} and Chan, {Linda S.} and Ali Salim and Carlos Brown and Timothy Browder and Elizabeth Beale and Peter Rhee and Demetrios Demetriades",
year = "2008",
month = "3",
doi = "10.1016/j.jamcollsurg.2007.10.005",
language = "English (US)",
volume = "206",
pages = "432--438",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Beta-Blockers in Isolated Blunt Head Injury

AU - Inaba, Kenji

AU - Teixeira, Pedro G R

AU - David, Jean Stephane

AU - Chan, Linda S.

AU - Salim, Ali

AU - Brown, Carlos

AU - Browder, Timothy

AU - Beale, Elizabeth

AU - Rhee, Peter

AU - Demetriades, Demetrios

PY - 2008/3

Y1 - 2008/3

N2 - Background: The purpose of this study was to evaluate the effect of β-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that β-blocker exposure is associated with improved survival. Study Design: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score ≥ 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and β-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality. Results: During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received β-blockers and 953 (82%) did not. Patients receiving β-blockers were older (50 ± 21 years versus 38 ± 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score ≥ 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale ≤ 8 less often (37% versus 47%, p = 0.01), more skull fractures (20% versus 12%, p < 0.01), and underwent craniectomy more frequently (23% versus 4%, p < 0.001). Stepwise logistic regression identified β-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95% CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score ≥ 4) had a mortality of 28% on β-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p = 0.001). Conclusions: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with β-blockade.

AB - Background: The purpose of this study was to evaluate the effect of β-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that β-blocker exposure is associated with improved survival. Study Design: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score ≥ 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and β-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality. Results: During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received β-blockers and 953 (82%) did not. Patients receiving β-blockers were older (50 ± 21 years versus 38 ± 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score ≥ 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale ≤ 8 less often (37% versus 47%, p = 0.01), more skull fractures (20% versus 12%, p < 0.01), and underwent craniectomy more frequently (23% versus 4%, p < 0.001). Stepwise logistic regression identified β-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95% CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score ≥ 4) had a mortality of 28% on β-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p = 0.001). Conclusions: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with β-blockade.

UR - http://www.scopus.com/inward/record.url?scp=39549116490&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39549116490&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2007.10.005

DO - 10.1016/j.jamcollsurg.2007.10.005

M3 - Article

C2 - 18308212

AN - SCOPUS:39549116490

VL - 206

SP - 432

EP - 438

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 3

ER -