(1591) Outcomes of Patients With TBI Who Received Beta-Blockers at Two Academic Trauma Centers

Introduction: Current studies of beta blockers (BB) in traumatic brain injury (TBI) are limited by study design, small sample size, differing severity of TBI injury, and heterogenous patient population and BB regimen. The Eastern Association for the Surgery of Trauma Guidelines provide a conditional, weak recommendation for the use of in-hospital BB in adults with acute TBI without hypotension and symptomatic bradycardia, however, use in a real-world setting varies significantly. The objective of this study was to describe characteristics and outcomes of critically ill patients with TBI who received propranolol during their hospital stay.

Methods: This was a retrospective study of adult (>18 years) patients with TBI who were admitted to an intensive care unit (ICU) across two trauma centers between January 2015 and March 2023 and prescribed a BB. Patients were identified by ICD-10 code for TBI in the trauma registry and BB use was extracted from pharmacy records. The BB could have been prescribed at any time during the hospital stay. Patients prescribed BB infusions or only as needed orders were excluded. The primary outcome was hospital mortality. Secondary outcomes included hospital and ICU length of stay (LOS), duration of mechanical ventilation, and discharge disposition.

Results: A total of 251 patients were included; all patients received propranolol. The mean (standard deviation [SD]) age was 43.3 (18.8) years with 79.7% male and 57% white patients. The median (IQR) GCS and ISS were 6 (3-12) and 26 (18-33), respectively. The most common mechanisms of injury were motor vehicle collision (25.1%) and fall (21.5%); most patients (94.4%) presented with a blunt injury. Mortality was seen in one-fifth (19.9%) of the sample. Mean (SD) duration of mechanical ventilation was 17.4 (14.1) days, hospital LOS was 44.7 (57) days, and ICU LOS was 14.5 (11) days. Most patients were discharged to a rehabilitation facility (29.1%), followed by home or home health (27.1%).

Conclusions: Critically ill patients with TBI who were prescribed a BB had a mortality rate of nearly 20% and protracted hospital and ICU LOS. Further investigation is needed to determine the appropriate BB agent, dose, duration, and safety in this patient population. Future research should also assess benefits across TBI subgroups.