Beta‐Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial

Abstract

Abstract Background Observational studies have demonstrated improved outcomes in TBI patients receiving in‐hospital beta‐blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta‐blockers on outcomes in TBI patients. Methods Adult patients with severe TBI (intracranial AIS ≥ 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB−). Outcomes of interest were in‐hospital mortality and Glasgow Outcome Scale‐Extended (GOS‐E) score on discharge and at 6‐month follow‐up. Subgroup analysis including only isolated severe TBI (intracranial AIS ≥ 3 with extracranial AIS ≤ 2) was carried out. Poisson regression models were used. Results Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB + and BB − cohorts. No significant difference in in‐hospital mortality (adj. IRR 0.6 [95% CI 0.3–1.4], p = 0.2) or long‐term functional outcome was measured between the cohorts ( p = 0.3). One hundred fifty‐four patients suffered isolated severe TBI of whom 44% received BB. The BB + group had significantly lower mortality relative to the BB − group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in‐hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6‐month follow‐up (GOS‐E ≥ 5 adj. IRR 1.2, p = 0.02). Conclusion Propranolol decreases in‐hospital mortality and improves long‐term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta‐blocker therapy as part of a standardized neurointensive care protocol. Level of evidence Level II; therapeutic. Study type Therapeutic study.

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