Top

World Journal of Surgery

Published in:

01-08-2015 | Original Scientific Report

The Effect of β-blockade on Survival After Isolated Severe Traumatic Brain Injury

Authors: Shahin Mohseni, Peep Talving, Eric P. Thelin, Göran Wallin, Olle Ljungqvist, Louis Riddez

Published in: World Journal of Surgery | Issue 8/2015

Abstract

Background

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

Methods

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) ≥3 excluding extra-cranial injuries AIS ≥3. Multivariable logistic regression analysis was used to determine the effect of β-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission β-blocker versus not and the effect of specific type of β-blocker on the overall outcome.

Results

Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to β-blockers during their hospital admission. The exposed patients were older (62 ± 16 years vs. 49 ± 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS ≤8: 32 % vs. 28 %, p = 0.007; ISS ≥16: 71 % vs. 59 %, p = 0.001; head AIS ≥4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive β-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to β-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 β-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to β-blockers compared to those on pre-admission β-blocker therapy (AOR 3.0 CI 95 % 1.2–7.1, p = 0.015).

Conclusions

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

Thurman D (2001) The epidemiology and economics of head trauma. In: Miller L, Hayes R (eds) Head trauma: basic, preclinical, and clinical directions. Wiley, New York

Shackford SR, Mackersie RC, Holbrook TL et al (1993) The epidemiology of traumatic death. A population-based analysis. Arch Surg 128(5):571–575PubMedCrossRef

Corrigan JD, Selassie AW, Orman JA (2010) The epidemiology of traumatic brain injury. J Head Trauma Rehabil 25(2):72–80PubMedCrossRef

Cales RH, Trunkey DD (1985) Preventable trauma deaths. A review of trauma care systems development. JAMA 254(8):1059–1063PubMedCrossRef

Acosta JA, Yang JC, Winchell RJ et al (1998) Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 186(5):528–533PubMedCrossRef

Brain Trauma Foundation (2007) American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–106

Inaba K, Teixeira PG, David JS et al (2008) Beta-blockers in isolated blunt head injury. J Am Coll Surg 206(3):432–438. doi:10.1016/j.jamcollsurg.2007.10.005 PubMedCrossRef

Arbabi S, Campion EM, Hemmila MR et al (2007) Beta-blocker use is associated with improved outcomes in adult trauma patients. J Trauma 62(1):56–61; discussion 61-2

Cotton BA, Snodgrass KB, Fleming SB et al (2007) Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma 62(1):26–33; discussion 33-5

10.

Schroeppel TJ, Fischer PE, Zarzaur BL et al (2010) Beta-adrenergic blockade and traumatic brain injury: protective? J Trauma 69(4):776–782PubMedCrossRef

11.

Schroeppel TJ, Sharpe JP, Magnotti LJ et al (2014) Traumatic brain injury and beta-blockers: not all drugs are created equal. J Trauma Acute Care Surg 76(2):504–509PubMedCrossRef

12.

Bukur M, Mohseni S, Ley E et al (2012) Efficacy of beta-blockade after isolated blunt head injury: does race matter? J Trauma Acute Care Surg 72(4):1013–1018PubMed

13.

Hortnagl H, Hammerle AF, Hackl JM, Brucke T, Rumpl E, Hortnagl H (1980) The activity of the sympathetic nervous system following severe head injury. Intensive Care Med 6(3):169-1-7

14.

Clifton GL, Ziegler MG, Grossman RG (1981) Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 8(1):10–14PubMedCrossRef

15.

Hamill RW, Woolf PD, McDonald JV, Lee LA, Kelly M (1987) Catecholamines predict outcome in traumatic brain injury. Ann Neurol 21(5):438–443PubMedCrossRef

16.

Liu MY (1995) Protective effects of propranolol on experimentally head-injured mouse brains. J Formos Med Assoc 94(7):386–390PubMed

17.

Kemp CD, Johnson JC, Riordan WP, Cotton BA (2008) How we die: the impact of nonneurologic organ dysfunction after severe traumatic brain injury. Am Surg 74(9):866–872PubMed

18.

Heffernan DS, Inaba K, Arbabi S, Cotton BA (2010) Sympathetic hyperactivity after traumatic brain injury and the role of beta-blocker therapy. J Trauma 69(6):1602–1609PubMedCrossRef

19.

Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ (2005) Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med 33(3):654–660PubMedCrossRef

20.

Piek J, Chesnut RM, Marshall LF et al (1992) Extracranial complications of severe head injury. J Neurosurg 77(6):901–907PubMedCrossRef

21.

Grunsfeld A, Fletcher JJ, Nathan BR (2005) Cardiopulmonary complications of brain injury. Curr Neurol Neurosci Rep 5(6):488–493PubMedCrossRef

22.

Clifton GL, Robertson CS, Kyper K, Taylor AA, Dhekne RD, Grossman RG (1983) Cardiovascular response to severe head injury. J Neurosurg 59(3):447–454PubMedCrossRef

23.

Clifton GL, Robertson CS, Grossman RG (1989) Cardiovascular and metabolic responses to severe head injury. Neurosurg Rev 12(Suppl 1):465–473PubMedCrossRef

24.

Woiciechowsky C, Asadullah K, Nestler D et al (1998) Sympathetic activation triggers systemic interleukin-10 release in immunodepression induced by brain injury. Nat Med 4(7):808–813PubMedCrossRef

25.

Woolf PD, McDonald JV, Feliciano DV, Kelly MM, Nichols D, Cox C (1992) The catecholamine response to multisystem trauma. Arch Surg 127(8):899–903PubMedCrossRef

26.

Alexander RW, Davis JN, Lefkowitz RJ (1975) Direct identification and characterisation of beta-adrenergic receptors in rat brain. Nature 258(5534):437–440PubMedCrossRef

27.

MacKenzie ET, McCulloch J, Harper AM (1976) Influence of endogenous norepinephrine on cerebral blood flow and metabolism. Am J Physiol 231(2):489–494PubMed

28.

Meyer JS, Miyakawa Y, Welch KM et al (1976) Influence of adrenergic receptor blockade on circulatory and metabolic effects of disordered neurotransmitter function in stroke patients. Stroke 7(2):158–167PubMedCrossRef

29.

Neil-Dwyer G, Cruickshank JM, Doshi R (1990) The stress response in subarachnoid haemorrhage and head injury. Acta Neurochir Suppl (Wien) 47:102–110

30.

Naredi S, Lambert G, Eden E et al (2000) Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke 31(4):901–906PubMedCrossRef

31.

Asgeirsson B, Grande PO, Nordstrom CH (1994) A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med 20(4):260–267PubMedCrossRef

32.

Eker C, Asgeirsson B, Grande PO, Schalen W, Nordstrom CH (1998) Improved outcome after severe head injury with a new therapy based on principles for brain volume regulation and preserved microcirculation. Crit Care Med 26(11):1881–1886PubMedCrossRef

33.

www.SCB.se. Statistics Sweden, data acquired 2014-01-04

34.

Kraus JF, Fife D, Ramstein K, Conroy C, Cox P (1986) The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, san diego county, california. Am J Public Health 76(11):1345–1347PubMedCentralPubMedCrossRef

35.

Sorani MD, Lee M, Kim H, Meeker M, Manley GT (2009) Race\ethnicity and outcome after traumatic brain injury at a single, diverse center. J Trauma 67(1):75–80PubMedCrossRef

36.

Jager TE, Weiss HB, Coben JH, Pepe PE (2000) Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Acad Emerg Med 7(2):134–140PubMedCrossRef

37.

Bowman SM, Martin DP, Sharar SR, Zimmerman FJ (2007) Racial disparities in outcomes of persons with moderate to severe traumatic brain injury. Med Care 45(7):686–690PubMedCrossRef

38.

Mayer SA, Kurtz P, Wyman A et al (2011) Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the studying the treatment of acute hyperTension registry. Crit Care Med 39(10):2330–2336PubMedCrossRef

39.

Rose JC, Mayer SA (2004) Optimizing blood pressure in neurological emergencies. Neurocrit Care 1(3):287–299PubMedCrossRef

Title: The Effect of β-blockade on Survival After Isolated Severe Traumatic Brain Injury
Authors: Shahin Mohseni
Peep Talving
Eric P. Thelin
Göran Wallin
Olle Ljungqvist
Louis Riddez
Publication date: 01-08-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3039-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Effect of β-blockade on Survival After Isolated Severe Traumatic Brain Injury

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2015

Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated?

Merged Near-Infrared and White-Light Imaging in Minimally Invasive Surgery

Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary Thyroid Carcinoma

Bilateral and Unilateral Total Extraperitoneal Inguinal Hernia Repair (TEP) have Equivalent Early Outcomes: Analysis of 9395 Cases

Changing Trends in Thyroid and Parathyroid Surgery Over the Decade: Is Same Day Discharge Feasible in the United Kingdom?: Reply

Level of Evidence Analysis for the Latest German National Guideline on Treatment of Patients with Severe and Multiple Injuries and ATLS