Effects of early propranolol administration on mortality from severe, traumatic brain injury: a retrospective propensity score-matched registry study

Abstract

Background: The role of beta-blockers in severe, traumatic brain injury (TBI) management is debated. Severe TBI may elicit a surge of catecholamines, which has been associated with increased morbidity and mortality. We hypothesize administering propranolol, a non-selective beta-blocker, within 48 h of TBI will reduce patient mortality within 30 days of injury. The TriNetX database was leveraged to determine if administering a propranolol within 48 h of severe TBI improves outcomes within 30 days of injury.

Methods: The TriNetX Research Network was used to form two cohorts using retrospective data from 106,294,356 patient profiles from 9/10/2022, which included patients from years 2022 to 2022. The propranolol-receiving cohort included all patients who received the first-instance diagnosis of severe TBI (defined by a Glascow coma scale score of 3-8) and propranolol within 48 h of injury. The non-propranolol-receiving cohort included all patients with the same diagnosis of severe TBI but did not receive beta-blockers. The primary outcome of interest was mortality at 30 days. Secondary outcomes included gastrostomy tube placement, neurosurgical intervention in the form of craniotomy, craniectomy, burr hole drainage, seizure, and cardiac arrest.

Results: After propensity score-matching, 381 patients were identified for both cohorts. At 30 days post-severe TBI, 22.7% (84) of patients from the cohort that received propranolol, and 30.77% (116) from the cohort that did not, were deceased (OR 0.66), 95% CI [0.48, 0.92]), (p 0.01). TBI patients who received propranolol also had lower odds of requiring neurosurgical intervention, experience seizures, and cardiac arrest.

Conclusion: The results of this study demonstrate significantly reduced mortality within 30 days of injury and fewer neurosurgical interventions, seizures, and episodes of cardiac arrest in severe TBI patients who received propranolol within 48 h of injury.

Keywords: Betablocker; Neurocritical care; Traumatic brain injury.