Beta-Blockers in Isolated Blunt Head Injury

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.