Tignanelli Christopher J, Arbabi Saman, Iskander Gaby, Kralovich Kurt, Scott John, Sangji Naveen F, Hemmila Mark R
From the Department of Surgery, University of Minnesota, Minneapolis, MN.
Department of Surgery, University of Washington, Seattle, WA.
Ann Surg Open. 2023 Aug 29;4(3):e324. doi: 10.1097/AS9.0000000000000324. eCollection 2023 Sep.
Beta-adrenergic receptor blocker (BB) administration has been shown to improve survival after traumatic brain injury (TBI). However, studies to date that observe a benefit did not distinguish between continuation of preinjury BB versus de novo initiation of BB.
To determine the effect of continuation of preinjury BB and de novo initiation of BB on risk-adjusted mortality and complications for patients with TBI.
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 abbreviated injury scale (AIS) value of 3 to 5. Patients were placed into 4 groups based on the preinjury 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.
A total of 15,153 patients treated at 35 trauma centers were available for analysis. Patients were divided into 4 cohort groupings related to preinjury BB use and postinjury receipt of BB. The odds of mortality was significantly reduced for patients with a TBI on a preinjury BB who had the medication continued in the acute setting (as compared with patients on preinjury BB who did not) (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.54-0.98; = 0.04). Patients with a TBI who were not on preinjury BB did not benefit from de novo initiation of BB with regard to mortality (OR, 0.83; 95% CI, 0.64-1.08; = 0.2). In the sensitivity analysis, excluding polytrauma patients, patients on preinjury BB who had BB continued had a reduction in mortality when compared with patients in which BB was stopped following a TBI (OR, 0.65; 95% CI, 0.47-0.91; = 0.01).
Continuing BB is associated with reduced odds of mortality in patients with a TBI on preinjury BB. We were unable to demonstrate benefit from instituting beta blockade in patients who are not on a BB preinjury.
β-肾上腺素能受体阻滞剂（BB）的使用已被证明可提高创伤性脑损伤（TBI）后的生存率。然而，迄今为止观察到有益效果的研究并未区分伤前BB的持续使用与BB的从头开始使用。
确定伤前BB的持续使用和BB的从头开始使用对TBI患者风险调整后的死亡率和并发症的影响。
分析创伤质量协作数据（2016 - 2021年）。排除住院时间<48小时、直接入院或穿透伤的患者。重度TBI被定义为头部简明损伤定级标准（AIS）值为3至5。根据伤前BB的使用情况和住院期间BB的使用情况将患者分为4组。使用倾向评分匹配法创建1:1匹配的患者队列进行比较。计算考虑医院聚类的死亡率比值比。进行敏感性分析，排除所有其他身体部位AIS>2损伤的患者，以创建孤立TBI患者队列。
共有35个创伤中心治疗的15153例患者可供分析。患者根据伤前BB的使用情况和伤后BB的接受情况分为4个队列分组。伤前使用BB且在急性情况下继续使用该药物的TBI患者的死亡几率显著降低（与伤前使用BB但未继续使用的患者相比）（比值比[OR]，0.73；95%置信区间[CI]，0.54 - 0.98；P = 0.04）。伤前未使用BB的TBI患者在死亡率方面未从BB的从头开始使用中获益（OR，0.83；95% CI，0.64 - 1.08；P = 0.2）。在敏感性分析中，排除多发伤患者后，伤前使用BB且继续使用BB的患者与TBI后停用BB的患者相比，死亡率降低（OR，0.65；95% CI，0.47 - 0.91；P = 0.01）。
伤前使用BB的TBI患者继续使用BB与死亡几率降低相关。我们未能证明伤前未使用BB的患者使用β受体阻滞剂有益。
