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β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study
Purpose Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented. Methods Adult patients with severe TBI...
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| Published in: | European journal of trauma and emergency surgery (Munich : 2007) 2017-12, Vol.43 (6), p.783-789 |
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| container_end_page | 789 |
| container_issue | 6 |
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| container_title | European journal of trauma and emergency surgery (Munich : 2007) |
| container_volume | 43 |
| creator | Ahl, R. Thelin, E. P. Sjölin, G. Bellander, B.-M. Riddez, L. Talving, P. Mohseni, S. |
| description | Purpose
Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.
Methods
Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay |
| doi_str_mv | 10.1007/s00068-017-0779-5 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_498544</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1876492744</sourcerecordid><originalsourceid>FETCH-LOGICAL-c595t-38f4a98f866bdfb56a70bc60bf2d6db5de053f647112c7bdd2637597526e9393</originalsourceid><addsrcrecordid>eNp1kstu1DAUhiMEou3AA7BBltiwIOBLbMcsKpVylSqxqdhajuPMeJrEg-20mjVv1AfhmTjDTIcWaRa2j-zvP8fH_oviBcFvCcbyXcIYi7rERJZYSlXyR8UxqQUrlarI433M2FFxktISYCw4fVoc0ZpKXrPquPj1-7b80Ad75SIyXYY5uWsXHcrRTIPJ3qImGj8iPy6nuEY-IZNSsN5k16IbnxeocXmj68M4LyEYUDeNNvswmh6FKdswuPfIIEhmF6CxJjlkw5hj6FHKU7t-VjzpTJ_c8906Ky4_f7o8_1pefP_y7fzsorRc8VyyuquMqrtaiKbtGi6MxI0VuOloK9qGtw5z1olKEkKtbNqWCia5kpwKp5his6Lcpk03bjU1ehX9YOJaB-P1busKIqcrVfOqAl4d5FcxtP9Ed0LCJCWVFBvtm4Paj_7HmQ5xDmPSXLIaA366xYEdXGsdvI7pH1Z8cDL6hZ6Ha5BjSaHPWfF6lyCGn5NLWQ8-Wdf3ZnRhSprUcCtF5d-2Xv2HLsMU4bOAUhJTzCglQJEtZWNIKbpufxmC9cZ8ems-DebTG_NpDpqX97vYK-7cBgDdvQocjXMX75U-mPUP2jDqTg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1970203221</pqid></control><display><type>article</type><title>β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study</title><source>Springer Nature</source><creator>Ahl, R. ; Thelin, E. P. ; Sjölin, G. ; Bellander, B.-M. ; Riddez, L. ; Talving, P. ; Mohseni, S.</creator><creatorcontrib>Ahl, R. ; Thelin, E. P. ; Sjölin, G. ; Bellander, B.-M. ; Riddez, L. ; Talving, P. ; Mohseni, S.</creatorcontrib><description>Purpose
Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.
Methods
Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.
Results
362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days,
p
< 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01–6.03,
p
= 0.03).
Conclusion
Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.</description><identifier>ISSN: 1863-9933</identifier><identifier>ISSN: 1863-9941</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-017-0779-5</identifier><identifier>PMID: 28275834</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adrenergic beta-Antagonists - administration & dosage ; Adrenergic beta-Antagonists - therapeutic use ; Brain Injuries, Traumatic - drug therapy ; Brain Injuries, Traumatic - mortality ; Brain Injuries, Traumatic - rehabilitation ; Case-Control Studies ; Critical Care Medicine ; Emergency Medicine ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Intensive ; Kirurgi ; Length of Stay ; Male ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Middle Aged ; Original ; Original Article ; Recovery of Function ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Survival Analysis ; Sweden ; Traumatic brain injury ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2017-12, Vol.43 (6), p.783-789</ispartof><rights>The Author(s) 2017</rights><rights>European Journal of Trauma and Emergency Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-38f4a98f866bdfb56a70bc60bf2d6db5de053f647112c7bdd2637597526e9393</citedby><cites>FETCH-LOGICAL-c595t-38f4a98f866bdfb56a70bc60bf2d6db5de053f647112c7bdd2637597526e9393</cites><orcidid>0000-0001-7097-487X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28275834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-57380$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:137214764$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahl, R.</creatorcontrib><creatorcontrib>Thelin, E. P.</creatorcontrib><creatorcontrib>Sjölin, G.</creatorcontrib><creatorcontrib>Bellander, B.-M.</creatorcontrib><creatorcontrib>Riddez, L.</creatorcontrib><creatorcontrib>Talving, P.</creatorcontrib><creatorcontrib>Mohseni, S.</creatorcontrib><title>β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Purpose
Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.
Methods
Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.
Results
362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days,
p
< 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01–6.03,
p
= 0.03).
Conclusion
Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.</description><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Brain Injuries, Traumatic - drug therapy</subject><subject>Brain Injuries, Traumatic - mortality</subject><subject>Brain Injuries, Traumatic - rehabilitation</subject><subject>Case-Control Studies</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Intensive</subject><subject>Kirurgi</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Original Article</subject><subject>Recovery of Function</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Survival Analysis</subject><subject>Sweden</subject><subject>Traumatic brain injury</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kstu1DAUhiMEou3AA7BBltiwIOBLbMcsKpVylSqxqdhajuPMeJrEg-20mjVv1AfhmTjDTIcWaRa2j-zvP8fH_oviBcFvCcbyXcIYi7rERJZYSlXyR8UxqQUrlarI433M2FFxktISYCw4fVoc0ZpKXrPquPj1-7b80Ad75SIyXYY5uWsXHcrRTIPJ3qImGj8iPy6nuEY-IZNSsN5k16IbnxeocXmj68M4LyEYUDeNNvswmh6FKdswuPfIIEhmF6CxJjlkw5hj6FHKU7t-VjzpTJ_c8906Ky4_f7o8_1pefP_y7fzsorRc8VyyuquMqrtaiKbtGi6MxI0VuOloK9qGtw5z1olKEkKtbNqWCia5kpwKp5his6Lcpk03bjU1ehX9YOJaB-P1busKIqcrVfOqAl4d5FcxtP9Ed0LCJCWVFBvtm4Paj_7HmQ5xDmPSXLIaA366xYEdXGsdvI7pH1Z8cDL6hZ6Ha5BjSaHPWfF6lyCGn5NLWQ8-Wdf3ZnRhSprUcCtF5d-2Xv2HLsMU4bOAUhJTzCglQJEtZWNIKbpufxmC9cZ8ems-DebTG_NpDpqX97vYK-7cBgDdvQocjXMX75U-mPUP2jDqTg</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Ahl, R.</creator><creator>Thelin, E. P.</creator><creator>Sjölin, G.</creator><creator>Bellander, B.-M.</creator><creator>Riddez, L.</creator><creator>Talving, P.</creator><creator>Mohseni, S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>AABEP</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>D91</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-7097-487X</orcidid></search><sort><creationdate>20171201</creationdate><title>β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study</title><author>Ahl, R. ; Thelin, E. P. ; Sjölin, G. ; Bellander, B.-M. ; Riddez, L. ; Talving, P. ; Mohseni, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c595t-38f4a98f866bdfb56a70bc60bf2d6db5de053f647112c7bdd2637597526e9393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Brain Injuries, Traumatic - drug therapy</topic><topic>Brain Injuries, Traumatic - mortality</topic><topic>Brain Injuries, Traumatic - rehabilitation</topic><topic>Case-Control Studies</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Intensive</topic><topic>Kirurgi</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Original Article</topic><topic>Recovery of Function</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Survival Analysis</topic><topic>Sweden</topic><topic>Traumatic brain injury</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahl, R.</creatorcontrib><creatorcontrib>Thelin, E. P.</creatorcontrib><creatorcontrib>Sjölin, G.</creatorcontrib><creatorcontrib>Bellander, B.-M.</creatorcontrib><creatorcontrib>Riddez, L.</creatorcontrib><creatorcontrib>Talving, P.</creatorcontrib><creatorcontrib>Mohseni, S.</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Örebro universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Örebro universitet</collection><collection>SwePub Articles full text</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahl, R.</au><au>Thelin, E. P.</au><au>Sjölin, G.</au><au>Bellander, B.-M.</au><au>Riddez, L.</au><au>Talving, P.</au><au>Mohseni, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>43</volume><issue>6</issue><spage>783</spage><epage>789</epage><pages>783-789</pages><issn>1863-9933</issn><issn>1863-9941</issn><eissn>1863-9941</eissn><abstract>Purpose
Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.
Methods
Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.
Results
362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days,
p
< 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01–6.03,
p
= 0.03).
Conclusion
Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28275834</pmid><doi>10.1007/s00068-017-0779-5</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7097-487X</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1863-9933 |
| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2017-12, Vol.43 (6), p.783-789 |
| issn | 1863-9933 1863-9941 1863-9941 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_498544 |
| source | Springer Nature |
| subjects | Adrenergic beta-Antagonists - administration & dosage Adrenergic beta-Antagonists - therapeutic use Brain Injuries, Traumatic - drug therapy Brain Injuries, Traumatic - mortality Brain Injuries, Traumatic - rehabilitation Case-Control Studies Critical Care Medicine Emergency Medicine Female Glasgow Coma Scale Humans Injury Severity Score Intensive Kirurgi Length of Stay Male Medicin och hälsovetenskap Medicine Medicine & Public Health Middle Aged Original Original Article Recovery of Function Sports Medicine Surgery Surgical Orthopedics Survival Analysis Sweden Traumatic brain injury Traumatic Surgery |
| title | β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study |
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