Beta-Adrenergic Blockade and Traumatic Brain Injury: Protective?

Schroeppel, Thomas J.; Fischer, Peter; Zarzaur, Ben L.; Magnotti, Louis J.; Clement, L. Paige; Fabian, Timothy C.; Croce, Martin A.

doi:10.1097/ta.0b013e3181e981b8

Cited by 54 publications

(59 citation statements)

References 40 publications

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“…Recently, several retrospective clinical studies from North America have shown positive effects of in-hospital b-blocker exposure on the overall outcome after TBI [7][8][9][10][11][12]18]. In our current investigation, we observed similar overall incidence of b-blocker exposure in headinjured patients and we noted, likewise, positive results on survival in our studied population.…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2015

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Section: Discussionsupporting

confidence: 91%

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

et al. 2015

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“…The cohort studies included only hospitalized adult patients with TBI as defined by the Head Abbreviated Injury Scale (AIS) score or by using the International Statistical Classification of Diseases, Ninth Revision (ICD-9CM) code for blunt TBI (48–50,54,57–60). The exposures in the included studies were defined as any β-blockers agent, regardless of dose, route of administration, or pre-hospital exposure.…”

Section: Resultsmentioning

confidence: 99%

“…Hospital mortality was assessed by all cohort studies but not by the RCT (48–50,54). None of the included studies examined functional outcome or quality of life measures.…”

Section: Resultsmentioning

confidence: 99%

Beta-blockers and Traumatic Brain Injury

et al. 2017

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OBJECTIVE To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age≥16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g. hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I2). RESULTS Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95%CI: 0.27–0.56; I2=65%, p<0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

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“…More recently, Schroeppel et al [9] evaluated all patients with blunt TBI admitted to the Presley Regional Trauma Center between 2003-2007 in order to assess the survival benefit of beta-blocker exposure in the largest retrospective study to date, which included 2601 patients. Beta-blocker exposure was defined as having received more than one dose of any beta-blocker during the admission.…”

Section: Beta-blockersmentioning

confidence: 98%

Emerging pharmacological agents to improve survival from traumatic brain injury

2013

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Emerging pharmacological agents represent promising treatment options for traumatic brain injury to improve survival. Most of these agents are commercially available for other indications. However, limitations in study design, sample size, duration of treatment, timing of treatment and inclusion of heterogeneous patient populations make it difficult to draw definitive conclusions from the literature.

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Beta-Adrenergic Blockade and Traumatic Brain Injury: Protective?

Cited by 54 publications

References 40 publications

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

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

Beta-blockers and Traumatic Brain Injury

Emerging pharmacological agents to improve survival from traumatic brain injury

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