Beta-Blockers and Traumatic Brain Injury: A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline

Aziz S. Alali, Kaushik Mukherjee, Victoria A. McCredie, Eyal Golan, Prakesh S. Shah, James M. Bardes, Susan E. Hamblin, Elliott Haut, James C. Jackson, Kosar Khwaja, Nimitt J. Patel, Satish R. Raj, Laura D. Wilson, Avery B. Nathens, Mayur B. Patel

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND:: There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS:: Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g., hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I). RESULTS:: Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95% CI: 0.27–0.56; I = 65%, P < 0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS:: In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - May 18 2017

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Meta-Analysis
Guidelines
Wounds and Injuries
Quality of Life
Brain Injuries
Odds Ratio
Confidence Intervals
Bronchial Spasm
Mortality
Traumatic Brain Injury
Therapeutics
Bradycardia
Hospital Mortality
MEDLINE
Hypotension
Observational Studies
Inpatients
Hospitalization
Heart Failure
Databases

ASJC Scopus subject areas

  • Surgery

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Beta-Blockers and Traumatic Brain Injury : A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline. / Alali, Aziz S.; Mukherjee, Kaushik; McCredie, Victoria A.; Golan, Eyal; Shah, Prakesh S.; Bardes, James M.; Hamblin, Susan E.; Haut, Elliott; Jackson, James C.; Khwaja, Kosar; Patel, Nimitt J.; Raj, Satish R.; Wilson, Laura D.; Nathens, Avery B.; Patel, Mayur B.

In: Annals of Surgery, 18.05.2017.

Research output: Contribution to journalArticle

Alali, AS, Mukherjee, K, McCredie, VA, Golan, E, Shah, PS, Bardes, JM, Hamblin, SE, Haut, E, Jackson, JC, Khwaja, K, Patel, NJ, Raj, SR, Wilson, LD, Nathens, AB & Patel, MB 2017, 'Beta-Blockers and Traumatic Brain Injury: A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002286
Alali, Aziz S. ; Mukherjee, Kaushik ; McCredie, Victoria A. ; Golan, Eyal ; Shah, Prakesh S. ; Bardes, James M. ; Hamblin, Susan E. ; Haut, Elliott ; Jackson, James C. ; Khwaja, Kosar ; Patel, Nimitt J. ; Raj, Satish R. ; Wilson, Laura D. ; Nathens, Avery B. ; Patel, Mayur B. / Beta-Blockers and Traumatic Brain Injury : A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline. In: Annals of Surgery. 2017.
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title = "Beta-Blockers and Traumatic Brain Injury: A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline",
abstract = "OBJECTIVE:: To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND:: There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS:: Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g., hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95{\%} confidence intervals (CI) and statistical heterogeneity (I). RESULTS:: Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95{\%} CI: 0.27–0.56; I = 65{\%}, P < 0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS:: In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.",
author = "Alali, {Aziz S.} and Kaushik Mukherjee and McCredie, {Victoria A.} and Eyal Golan and Shah, {Prakesh S.} and Bardes, {James M.} and Hamblin, {Susan E.} and Elliott Haut and Jackson, {James C.} and Kosar Khwaja and Patel, {Nimitt J.} and Raj, {Satish R.} and Wilson, {Laura D.} and Nathens, {Avery B.} and Patel, {Mayur B.}",
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T1 - Beta-Blockers and Traumatic Brain Injury

T2 - A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline

AU - Alali, Aziz S.

AU - Mukherjee, Kaushik

AU - McCredie, Victoria A.

AU - Golan, Eyal

AU - Shah, Prakesh S.

AU - Bardes, James M.

AU - Hamblin, Susan E.

AU - Haut, Elliott

AU - Jackson, James C.

AU - Khwaja, Kosar

AU - Patel, Nimitt J.

AU - Raj, Satish R.

AU - Wilson, Laura D.

AU - Nathens, Avery B.

AU - Patel, Mayur B.

PY - 2017/5/18

Y1 - 2017/5/18

N2 - OBJECTIVE:: To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND:: There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS:: Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g., hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I). RESULTS:: Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95% CI: 0.27–0.56; I = 65%, P < 0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS:: In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

AB - OBJECTIVE:: To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND:: There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS:: Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g., hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I). RESULTS:: Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95% CI: 0.27–0.56; I = 65%, P < 0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS:: In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

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