Association of Discontinuing Pre-Injury Beta-Adrenergic Blockade Medication with Mortality in Severe Blunt Traumatic Brian Injury

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Surg


Introduction: Beta-adrenergic receptor blocker (BB) administration has been shown to improve survival after traumatic brain injury (TBI). We examined the association between pre-injury BB use and administration of BB in the acute setting on mortality in patients with TBI.

Methods: Trauma quality collaborative data (2016-2021) were analyzed. Patients were excluded with hospitalization <48 hours, direct admission, or penetrating injury. Severe TBI was identified as a head AIS value of 3-5. Patients were placed into four groups based on pre-injury BB use and administration of BB during hospitalization. Propensity score matching was used to create 1:1 matched cohorts of patients for comparisons. Odd ratios of mortality accounting for hospital clustering were calculated. A sensitivity analysis was performed excluding patients with AIS>2 injuries in all other body regions to create a cohort of isolated TBI patients.

Results: 15,171 patients treated at 35 trauma centers were available for analysis. Patients were divided into the following cohort groupings: Pre-injury BB-/TBI BB- (N = 9,305), Pre-injury BB+/ TBI BB- (N = 1,605), Pre-injury BB-/TBI BB+ (N = 1,404), Pre-injury BB+/TBI BB+ (N = 2,857). The risk of mortality was significantly increased for patients on a pre-injury BB who did not have the medication continued in the acute setting of a TBI. These findings remained significant after excluding poly-trauma patients in sensitivity analysis.

Conclusion: In patients with a TBI who were on pre-injury BB, discontinuing BB is associated with a survival disadvantage. We were unable to demonstrate benefit from instituting beta blockade in patients who are not on a BB pre-injury.





First Page