Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

Margot Kelly-Hedrick; Sunny Yang Liu; Jordan Komisarow; Jordan Hatfield; Tetsu Ohnuma; Miriam M Treggiari; Katharine Colton; Evangeline Arulraja; Monica S Vavilala; Daniel T Laskowitz; Joseph P Mathew; Adrian Hernandez; Michael L James; Karthik Raghunathan; Vijay Krishnamoorthy

doi:10.1177/08850666241236724

Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

J Intensive Care Med. 2024 Mar 6:8850666241236724. doi: 10.1177/08850666241236724. Online ahead of print.

Authors

Margot Kelly-Hedrick^{1

2}, Sunny Yang Liu^{1

2}, Jordan Komisarow^{1

3}, Jordan Hatfield^{1

3}, Tetsu Ohnuma^{1

4}, Miriam M Treggiari^{1

4

5}, Katharine Colton⁶, Evangeline Arulraja¹, Monica S Vavilala⁷, Daniel T Laskowitz⁶, Joseph P Mathew⁴, Adrian Hernandez⁸, Michael L James⁴, Karthik Raghunathan^{1

4

5}, Vijay Krishnamoorthy^{1

4

5}

Affiliations

¹ Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, USA.
² Duke University School of Medicine, Durham, NC, USA.
³ Department of Neurosurgery, Duke University, Durham, NC, USA.
⁴ Department of Anesthesiology, Duke University, Durham, NC, USA.
⁵ Department of Population Health Sciences, Duke University, Durham, NC, USA.
⁶ Department of Neurology, Duke University, Durham, NC, USA.
⁷ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
⁸ Department of Medicine, Duke University, Durham, NC, USA.

PMID: 38449336
DOI: 10.1177/08850666241236724

Abstract

Background: There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking.

Objective: The present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI.

Methods: We conducted a retrospective cohort study of the administrative claims Premier Healthcare Database of adults (≥17 years) with moderate-severe TBI admitted to the intensive care unit (ICU) from 2016 to 2020. The exposure was receipt of a beta-blocker during day 1 or 2 of ICU stay (BB⁺). The primary outcome was hospital mortality, and secondary outcomes were: hospital length of stay (LOS), ICU LOS, discharge to home, and vasopressor utilization. In a sensitivity analysis, we explored the association of beta-blocker class (cardioselective and noncardioselective) with hospital mortality. We used propensity weighting methods to address possible confounding by treatment indication.

Results: A total of 109 665 participants met inclusion criteria and 39% (n = 42 489) were exposed to beta-blockers during the first 2 days of hospitalization. Of those, 42% received cardioselective only, 43% received noncardioselective only, and 14% received both. After adjustment, there was no association with hospital mortality in the BB⁺ group compared to the BB^- group (adjusted odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.94, 1.04). The BB⁺ group had longer hospital stays, lower chance of discharged home, and lower risk of vasopressor utilization, although these difference were clinically small. Beta-blocker class was not associated with hospital mortality.

Conclusion: In this retrospective cohort study, we found variation in use of beta-blockers and early exposure was not associated with hospital mortality. Further research is necessary to understand the optimal type, dose, and timing of beta-blockers for this population.

Keywords: beta-blockers; shock; traumatic brain injury; vasopressors.