(1773) Impact of Propranolol Versus No Beta-Blocker in Traumatic Brain Injury at a Level 1 Trauma Center

Introduction: Studies evaluating the use of beta blockers (BB) in traumatic brain injury (TBI) are limited by study design, small sample size, differing severity of TBI injury, heterogeneous patient population and BB regimen. The Eastern Association for the Surgery of Trauma Guidelines provide a conditional and weak recommendation for the use of in-hospital BB in adults with acute TBI, however, their use in clinical practice varies significantly. The objective of this study was to compare outcomes of critically ill patients with TBI who received propranolol versus those who did not receive any BB during their hospital stay.

Methods: This was a retrospective study of adults (>18 years) with TBI who were admitted to an intensive care unit (ICU) at a level 1 trauma center between Jan 2015 and Apr 2023. Patients who received >2 doses of propranolol during their hospital stay were compared to those who did not receive any BB. Patients who were pregnant, transferred from an outside hospital, or received BB infusions or only as needed BB were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included hospital and ICU length of stay (LOS), discharge disposition, and bradycardia.

Results: A total of 1579 patients were included; 217 propranolol, 1362 no BB. The mean age was 48.8 (+/- 20.4) years, 93.7% had blunt injury, and 64.5% were Caucasian. The propranolol group included more male patients (80.6% vs 72.2%, p = 0.009), extracranial injury (69.6% vs 41.4%, p < 0.001), intracranial hemorrhage (95.9% vs 80.7%, p < 0.001), and severe TBI (65.9% vs 21.7%, p < 0.001). Mortality, ICU and hospital LOS were higher with propranolol vs no BB and less patients were discharged home/home health (27.2% vs 53.2%, p < 0.001). Bradycardia was lower in the propranolol group (40.1 vs 50.6%, p = 0.004). These results remained consistent when stratifying by mild/moderate TBI, however there was lower mortality with propranolol in patients with severe TBI (21% vs 47%, p < 0.001).

Conclusions: Critically ill patients with TBI who received propranolol had worse outcomes as compared to patients who did not receive a beta blocker. However, in the subgroup of patients with severe TBI, mortality was decreased with propranolol use. Propranolol was not associated with an increased incidence of bradycardia.