Abstract
BackgroundObservational 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.MethodsAdult 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.ResultsTwo 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 in-hospital 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).ConclusionPropranolol 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 evidenceLevel II; therapeutic.Study typeTherapeutic study.
Highlights
MethodsTraumatic injury is one of the most common causes of death in people under the age of forty worldwide, and onethird of all trauma-related deaths are a result of intracranial insults [1]
incidence rate ratios (IRRs) 0.6 [95% confidence intervals (CI) 0.3–1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3)
Research is focused on measures that can reduce the incidence of secondary injury processes to improve survival and functional outcome after traumatic brain injury (TBI)
Summary
Traumatic injury is one of the most common causes of death in people under the age of forty worldwide, and onethird of all trauma-related deaths are a result of intracranial insults [1]. Intracranial injury is the product of a primary hit and a secondary hit. The primary injury occurs at the time of trauma and can only be addressed through preventative measures. Secondary injury is caused by complications of the primary insult and is driven through processes such as hypoxia, cerebral edema and ischemia [2, 3]. Research is focused on measures that can reduce the incidence of secondary injury processes to improve survival and functional outcome after traumatic brain injury (TBI). Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital betablockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients
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