(1772) Impact of Holding Home Beta-Blocker Therapy During Hospitalization in Traumatic Brain Injury

Introduction: Beta blockers (BB) reduce catecholamines and may improve outcomes for patients with traumatic brain injury (TBI). However, not all patients are eligible for BB therapy and there is limited data regarding withholding BB therapy during hospitalization in critically ill patients with TBI and pre-exposure to BB. The objective of this study was to evaluate critically ill patients with TBI who did not receive any BB during their hospital stay and compare outcomes in patients on home BB therapy versus those who were not exposed to BB prior to hospitalization.

Methods: This was a retrospective study of adult patients with TBI admitted between January 2015 and April 2023 to an intensive care unit (ICU) at a level 1 trauma center. Patients were excluded if they received any beta blockers during their hospital admission, were transferred from an outside hospital, or were pregnant. Patients on home BB therapy were compared to those not on BB therapy prior to hospitalization. The primary outcome was in-hospital mortality. Secondary outcomes included ICU length of stay (LOS), hospital LOS, discharge disposition, and bradycardia.

Results: Of the 1358 patients included, 81 were on home BB prior to admission and 1277 were not on home BB. Patients on home BB were older (mean [SD] age 67.3 vs. 48.6 [20.2] years, p < 0.001). Most patients had a blunt mechanism of injury (94.6%), mild TBI (68.9%), with mixed being the most common bleeding location (27.2%), followed by subdural hematoma (23.7%). The median admission GCS was 14 and 9.3% of patients required neurosurgery. Mortality (16% vs. 12.2%, p = 0.311), ICU LOS (4.4 [6.3] vs. 3.3 [4.9] days, p = 0.119), hospital LOS (9.8 [15.0] vs. 8.2 [16.2] days, p = 0.378), and discharge to home/home health (48.1% vs 53.4%, p = 0.641) were similar between groups. There was more bradycardia in the home BB group (67.9% vs. 51.4%, p = 0.012) and no difference in hypotension (32.1% vs 28.3%, p = 0.469).

Conclusions: Withholding home BB therapy during hospital stay in patients with mostly mild TBI was not associated with increased mortality, ICU LOS, or hospital LOS, and did not impact discharge disposition. Further studies are needed to determine the potential benefits of BB exposure before a TBI event and the risks of withholding therapy in more severe TBI.