Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study

Margot Kelly-Hedrick; Sunny Yang Liu; Nancy Temkin; Jason Barber; Jordan Komisarow; Geoffrey Manley; Tetsu Ohnuma; Katharine Colton; Miriam M Treggiari; Eric E Monson; Monica S Vavilala; Ramesh Grandhi; Daniel T Laskowitz; Joseph P Mathew; Adrian Hernandez; Michael L James; Karthik Raghunathan; Ben Goldstein; Amy J Markowitz; Vijay Krishnamoorthy

doi:10.1097/CCE.0000000000000958

Association of Early Beta-Blocker Exposure and Functional Outcomes in Critically Ill Patients With Moderate to Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study

Crit Care Explor. 2023 Sep 5;5(9):e0958. doi: 10.1097/CCE.0000000000000958. eCollection 2023 Sep.

Authors

Margot Kelly-Hedrick^{1

2}, Sunny Yang Liu^{1

2}, Nancy Temkin^{3

4}, Jason Barber⁴, Jordan Komisarow⁵, Geoffrey Manley⁶, Tetsu Ohnuma^{1

7}, Katharine Colton⁸, Miriam M Treggiari^{1

6

9}, Eric E Monson¹⁰, Monica S Vavilala¹¹, Ramesh Grandhi¹², Daniel T Laskowitz^{5

7

8}, Joseph P Mathew⁷, Adrian Hernandez¹³, Michael L James^{1

7

8}, Karthik Raghunathan^{1

7

9}, Ben Goldstein¹⁴, Amy J Markowitz⁶, Vijay Krishnamoorthy^{1

7

9}

Affiliations

¹ Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, NC.
² Duke University School of Medicine, Duke University, Durham, NC.
³ Departments of Biostatistics, University of Washington, Seattle, WA.
⁴ Departments of Neurosurgery, University of Washington, Seattle, WA.
⁵ Departments of Neurosurgery, Duke University, Durham, NC.
⁶ Departments of Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA.
⁷ Departments of Anesthesiology, Duke University, Durham, NC.
⁸ Departments of Neurology, Duke University, Durham, NC.
⁹ Departments of Population Health Sciences, Duke University, Durham, NC.
¹⁰ Libraries Center for Data and Visualization Sciences, Duke University, Durham, NC.
¹¹ Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
¹² Department of Neurosurgery, University of Utah, Salt Lake City, UT.
¹³ Departments of Medicine, Duke University, Durham, NC.
¹⁴ Departments of Biostatistics and Bioinformatics, Duke University, Durham, NC.

Abstract

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.

Keywords: beta blocker; cardioselective; disability; functional; traumatic brain injury.