TY - JOUR
T1 - Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients with Moderate to Severe Traumatic Brain Injury
T2 - A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study
AU - Kelly-Hedrick, Margot
AU - Liu, Sunny Yang
AU - Temkin, Nancy
AU - Barber, Jason
AU - Komisarow, Jordan
AU - Manley, Geoffrey
AU - Ohnuma, Tetsu
AU - Colton, Katharine
AU - Treggiari, Miriam M.
AU - Monson, Eric E.
AU - Vavilala, Monica S.
AU - Grandhi, Ramesh
AU - Laskowitz, Daniel T.
AU - Mathew, Joseph P.
AU - Hernandez, Adrian
AU - James, Michael L.
AU - Raghunathan, Karthik
AU - Goldstein, Ben
AU - Markowitz, Amy J.
AU - Krishnamoorthy, Vijay
AU - Badjatia, Neeraj
AU - Ferguson, Adam R.
AU - Foreman, Brandon
AU - McCrea, Michael
AU - Merchant, Randall
AU - Ngwenya, Laura B.
AU - Okonkwo, David
AU - Schnyer, David
AU - Yue, John K.
AU - Zafonte, Ross
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/9/5
Y1 - 2023/9/5
N2 - OBJECTIVES: We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate-severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury. DESIGN: Retrospective cohort study. SETTING: ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. PATIENTS: Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate-severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI. INTERVENTIONS: None. MEASUREMENTS: Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction. MAIN RESULTS: Of the 450 eligible participants, 57 (13%) received early beta blockers (BB+group). The BB+group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB+group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB+group and BB-group (odds ratio = 0.86; 95% CI, 0.48-1.53). There was no association between BB exposure and secondary outcomes. CONCLUSIONS: About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.
AB - OBJECTIVES: We aimed to 1) describe patterns of beta-blocker utilization among critically ill patients following moderate-severe traumatic brain injury (TBI) and 2) examine the association of early beta-blocker exposure with functional and clinical outcomes following injury. DESIGN: Retrospective cohort study. SETTING: ICUs at 18 level I, U.S. trauma centers in the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. PATIENTS: Greater than or equal to 17 years enrolled in the TRACK-TBI study with moderate-severe TBI (Glasgow Coma Scale of <13) were admitted to the ICU after a blunt TBI. INTERVENTIONS: None. MEASUREMENTS: Primary exposure was a beta blocker during the first 7 days in the ICU, with a primary outcome of 6-month Glasgow Outcome Scale-Extended (GOSE). Secondary outcomes included: length of hospital stay, in-hospital mortality, 6-month and 12-month mortality, 12-month GOSE score, and 6-month and 12-month measures of disability, well-being, quality of life, and life satisfaction. MAIN RESULTS: Of the 450 eligible participants, 57 (13%) received early beta blockers (BB+group). The BB+group was on average older, more likely to be on a preinjury beta blocker, and more likely to have a history of hypertension. In the BB+group, 34 participants (60%) received metoprolol only, 19 participants (33%) received propranolol only, 3 participants (5%) received both, and 1 participant (2%) received atenolol only. In multivariable regression, there was no difference in the odds of a higher GOSE score at 6 months between the BB+group and BB-group (odds ratio = 0.86; 95% CI, 0.48-1.53). There was no association between BB exposure and secondary outcomes. CONCLUSIONS: About one-sixth of subjects in our study received early beta blockers, and within this group, dose, and timing of beta-blocker administration varied substantially. No significant differences in GOSE score at 6 months were demonstrated, although our ability to draw conclusions is limited by overall low total doses administered compared with prior studies.
KW - beta blocker
KW - cardioselective
KW - disability
KW - functional
KW - traumatic brain injury
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U2 - 10.1097/CCE.0000000000000958
DO - 10.1097/CCE.0000000000000958
M3 - Article
AN - SCOPUS:85171801066
SN - 2639-8028
VL - 5
SP - E0958
JO - Critical Care Explorations
JF - Critical Care Explorations
IS - 9
ER -