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      β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study

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          Abstract

          Purpose

          Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.

          Methods

          Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.

          Results

          362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01–6.03, p = 0.03).

          Conclusion

          Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

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          Most cited references 23

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          The epidemiology of traumatic brain injury.

          To describe the most recent estimates of the incidence and prevalence of traumatic brain injury (TBI) and review current issues related to measurement and use of these data. State of the science literature for the United States and abroad was analyzed and issues were identified for (1) incidence of TBI, (2) prevalence of lifetime history of TBI, and (3) incidence and prevalence of disability associated with TBI. The most recent estimates indicate that each year 235 000 Americans are hospitalized for nonfatal TBI, 1.1 million are treated in emergency departments, and 50 000 die. The northern Finland birth cohort found that 3.8% of the population had experienced at least 1 hospitalization due to TBI by 35 years of age. The Christchurch New Zealand birth cohort found that by 25 years of age 31.6% of the population had experienced at least 1 TBI, requiring medical attention (hospitalization, emergency department, or physician office). An estimated 43.3% of Americans have residual disability 1 year after hospitalization with TBI. [corrected] The most recent estimate of the prevalence of US civilian residents living with disability following hospitalization with TBI is 3.2 million. Estimates of the incidence and prevalence of TBI are based on varying sources of data, methods of calculation, and assumptions. Informed users should be cognizant of the limitations of these estimates when determining their applicability.
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            Matching Using Estimated Propensity Scores: Relating Theory to Practice

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              Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.

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                Author and article information

                Contributors
                +46 8 517 700 00 , rebecka.ahl@karolinska.se
                +46 8 517 700 00 , eric.thelin@ki.se
                +46 19 602 13 95 , gabriel.sjolin@regionorebrolan.se
                +46 8 517 700 00 , bo-michael.bellander@karolinska.se
                +46 8 517 700 00 , louis.riddez@karolinska.se
                +372 5855 1603 , peep.talving@ut.ee
                +46 19 602 13 95 , mohsenishahin@yahoo.com
                Journal
                Eur J Trauma Emerg Surg
                Eur J Trauma Emerg Surg
                European Journal of Trauma and Emergency Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1863-9933
                1863-9941
                8 March 2017
                8 March 2017
                2017
                : 43
                : 6
                : 783-789
                Affiliations
                [1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Division of Trauma and Emergency Surgery, Department of Surgery, , Karolinska University Hospital, ; 171 76 Stockholm, Sweden
                [2 ]ISNI 0000 0001 0123 6208, GRID grid.412367.5, Division of Trauma and Emergency Surgery, Department of Surgery, , Orebro University Hospital, ; 701 85 Orebro, Sweden
                [3 ]ISNI 0000 0001 0738 8966, GRID grid.15895.30, School of Medical Sciences, , Orebro University, ; Orebro, Sweden
                [4 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Clinical Neuroscience, , Karolinska Institutet, ; Solna, 17176 Stockholm, Sweden
                [5 ]ISNI 0000 0001 0585 7044, GRID grid.412269.a, Department of Surgery, , Tartu University Hospital, ; Puusepa 8, Tartu, 50406 Estonia
                Article
                779
                10.1007/s00068-017-0779-5
                5707226
                28275834
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Categories
                Original Article
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                © Springer-Verlag GmbH Germany, part of Springer Nature 2017

                Emergency medicine & Trauma

                beta-blocker, traumatic brain injury, functional outcome

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