Hong Jinpyo, Stoltzfus Mason T, Hallan David R, Jareczek Francis J, Freedman Zachary, Bailey David, Rizk Elias, Park Haejoe
Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):44. doi: 10.1007/s00068-024-02699-1.
The role of beta-blockers in severe, traumatic brain injury (TBI) management is debated. Severe TBI may elicit a surge of catecholamines, which has been associated with increased morbidity and mortality. We hypothesize administering propranolol, a non-selective beta-blocker, within 48 h of TBI will reduce patient mortality within 30 days of injury. The TriNetX database was leveraged to determine if administering a propranolol within 48 h of severe TBI improves outcomes within 30 days of injury.
The TriNetX Research Network was used to form two cohorts using retrospective data from 106,294,356 patient profiles from 9/10/2022, which included patients from years 2022 to 2022. The propranolol-receiving cohort included all patients who received the first-instance diagnosis of severe TBI (defined by a Glascow coma scale score of 3-8) and propranolol within 48 h of injury. The non-propranolol-receiving cohort included all patients with the same diagnosis of severe TBI but did not receive beta-blockers. The primary outcome of interest was mortality at 30 days. Secondary outcomes included gastrostomy tube placement, neurosurgical intervention in the form of craniotomy, craniectomy, burr hole drainage, seizure, and cardiac arrest.
After propensity score-matching, 381 patients were identified for both cohorts. At 30 days post-severe TBI, 22.7% (84) of patients from the cohort that received propranolol, and 30.77% (116) from the cohort that did not, were deceased (OR 0.66), 95% CI [0.48, 0.92]), (p 0.01). TBI patients who received propranolol also had lower odds of requiring neurosurgical intervention, experience seizures, and cardiac arrest.
The results of this study demonstrate significantly reduced mortality within 30 days of injury and fewer neurosurgical interventions, seizures, and episodes of cardiac arrest in severe TBI patients who received propranolol within 48 h of injury.
β受体阻滞剂在严重创伤性脑损伤（TBI）治疗中的作用存在争议。严重TBI可能引发儿茶酚胺激增，这与发病率和死亡率增加有关。我们假设在TBI后48小时内给予普萘洛尔（一种非选择性β受体阻滞剂）将降低受伤后30天内的患者死亡率。利用TriNetX数据库来确定在严重TBI后48小时内给予普萘洛尔是否能改善受伤后30天内的结局。
使用TriNetX研究网络，利用2022年9月10日来自9/10/2022的106,294,356份患者资料中的回顾性数据形成两个队列，其中包括2022年的患者。接受普萘洛尔治疗的队列包括所有在受伤后48小时内首次被诊断为严重TBI（由格拉斯哥昏迷量表评分为3 - 8定义）并接受普萘洛尔治疗的患者。未接受普萘洛尔治疗 的队列包括所有诊断为严重TBI但未接受β受体阻滞剂治疗的患者。感兴趣的主要结局是30天的死亡率。次要结局包括胃造瘘管置入、开颅手术、颅骨切除术、钻孔引流、癫痫发作和心脏骤停等神经外科干预措施。
在倾向评分匹配后，两个队列各确定了381名患者。在严重TBI后30天，接受普萘洛尔治疗的队列中有22.7%（84名）患者死亡，未接受普萘洛尔治疗的队列中有30.77%（116名）患者死亡（OR 0.66），95% CI [0.48, 0.92]），（p 0.01）。接受普萘洛尔治疗的TBI患者需要神经外科干预、经历癫痫发作和心脏骤停的几率也较低。
本研究结果表明，在受伤后48小时内接受普萘洛尔治疗的严重TBI患者在受伤后30天内死亡率显著降低，神经外科干预、癫痫发作和心脏骤停事件减少。
