Beta-Blockers in Isolated Blunt Head Injury

Kenji Inaba, Pedro G.R. Teixeira, Jean Stephane David, Linda S. Chan, Ali Salim, Carlos Brown, Timothy Browder, Elizabeth Beale, Peter Rhee, Demetrios Demetriades

Research output: Contribution to journalArticlepeer-review

104 Scopus citations


Background: The purpose of this study was to evaluate the effect of β-blockers on patients sustaining acute traumatic brain injury. Our hypothesis was that β-blocker exposure is associated with improved survival. Study Design: The trauma registry and the surgical ICU databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2005. Patients sustaining major associated injuries (Abbreviated Injury Score ≥ 4 in any body region other than the head) were excluded. Patient demographics, injury profile, Injury Severity Score, and β-blocker exposure were abstracted. The primary outcomes measure evaluated was in-hospital mortality. Results: During the 90-month study period, 1,156 patients with isolated head injury were admitted to the ICU. Of these, 203 (18%) received β-blockers and 953 (82%) did not. Patients receiving β-blockers were older (50 ± 21 years versus 38 ± 20 years, p < 0.001), had more frequent severe (Abbreviated Injury Score ≥ 4) head injury (54% versus 43%, p < 0.01), Glasgow Coma Scale ≤ 8 less often (37% versus 47%, p = 0.01), more skull fractures (20% versus 12%, p < 0.01), and underwent craniectomy more frequently (23% versus 4%, p < 0.001). Stepwise logistic regression identified β-blocker use as an independent protective factor for mortality (adjusted odds ratio: 0.54; 95% CI, 0.33 to 0.91; p = 0.01). On subgroup analysis, elderly patients (55 years or older) with severe head injury (Abbreviated Injury Score ≥ 4) had a mortality of 28% on β-blockers as compared with 60% when they did not receive them (odds ratio: 0.3; 96% CI, 0.1 to 0.6; p = 0.001). Conclusions: Beta-blockade in patients with traumatic brain injury was independently associated with improved survival. Older patients with severe head injuries demonstrated the largest reduction in mortality with β-blockade.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalJournal of the American College of Surgeons
Issue number3
StatePublished - Mar 2008

ASJC Scopus subject areas

  • Surgery


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