Comparison of Beta-Blocker to No Beta-Blocker in Patients With Traumatic Brain Injury

Introduction: Traumatic brain injury (TBI) can lead to tissue and cellular damage resulting in excessive catecholamine release. This response may be mitigated by the early use of beta-blockers (BB), however, data supporting their benefit is limited. This study compared the use of BB to no BB in patients with TBI at an urban level 1 trauma center.


Methods: This was a retrospective chart review of all adult patients admitted between November 1, 2018, and April 30, 2023 with TBI and an intensive care unit (ICU) admission. Patients who received at least two consecutive doses of any scheduled BB were compared to those who did not receive any BB. The primary outcome was in-hospital mortality. Secondary outcomes were 28-day mortality, in-hospital length of stay (LOS), ICU LOS, and discharge disposition. Additional subgroup analyses compared propranolol vs other BB, early vs late BB initiation, and mild and moderate vs severe TBI. A logistic regression was performed to assess the association of BB usage with in-hospital mortality.


Results: Of 1194 patients included in the study, 375 received BB and 819 did not. Most patients were male (71.1%) and had a mean age of 53.5 years. Propranolol (42.1%) was the most commonly ordered BB, and 37.3% of patients received a BB within two days of admission. Compared to those who did not receive any BB, more patients in the BB group had severe TBI (37.3% vs 20.8%; p< 0.001), extra-cranial injuries (51.7% vs 40.8%; p< 0.001), and underwent neurosurgical interventions (18.9% vs 8.3%; p< 0.001). There was no difference in the rate of in-hospital mortality between both groups (13.1% vs 11.9%; p=0.570). However, in the multivariable logistic regression analysis, BB was associated with decreased in-hospital mortality (OR 0.589; 95% CI 0.381-0.909; p=0.017). ICU and hospital LOS were longer in the BB group (10.8±10.3 days vs 3.4±5.5; p< 0.001) and (29.6±48.8 vs 7.5±16.0; p< 0.001), respectively. No difference was observed in 28-day mortality. Initiation of a BB two or more days after admission was associated with higher in-hospital mortality (15.7% vs 8.6%; p=0.046).


Conclusions: Beta-blocker use was associated with reduced in-hospital mortality and observed in patients with severe TBI.