Association of Discontinuing Pre-Injury Beta-Adrenergic Blockade Medication with Mortality in Severe Blunt Traumatic Brian Injury
Tignanelli CJ, Arbabi S, Iskander GAP, Kralovich KA, Ledgerwood AM, Scott JW, Sangji N, and Hemmila MR. Association of Discontinuing Pre-Injury Beta-Adrenergic Blockade Medication with Mortality in Severe Blunt Traumatic Brian Injury. J Am Coll Surg 2022; 235(5):S90.
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.