Characterization of Propranolol Use and Outcomes in Traumatic Brain Injury at a Level I Trauma Center

Area of Science:

• Trauma Surgery
• Neurocritical Care
• Pharmacology

Background:

• Eastern Association for the Surgery of Trauma guidelines conditionally recommend beta blockers for adults with traumatic brain injury (TBI).
• Real-world utilization of beta blockers in TBI patients varies significantly.
• This study focuses on the use of propranolol in critically ill TBI patients.

Purpose of the Study:

• To describe the utilization patterns of propranolol in hospitalized patients with TBI.
• To evaluate secondary outcomes including mortality, length of stay, and discharge disposition.
• To assess the safety of propranolol administration, including adverse events like bradycardia and hypotension.

Main Methods:

• Retrospective study of 217 adult patients admitted with TBI to an ICU at a level 1 trauma center (January 2015 - April 2023).
• Data collected from institutional trauma registry and propranolol administration records.
• Primary outcome: description of propranolol use. Secondary outcomes: in-hospital mortality, 28-day mortality, ICU/hospital length of stay, discharge disposition, and safety events (bradycardia, hypotension, vasopressor use).

Main Results:

• Beta blockers (propranolol) were initiated on average by day 8 and administered for a mean duration of 22.9 days.
• In-hospital mortality was 18.9%, with 27.2% of patients discharged to home or home health.
• Adverse events included bradycardia in 40.1% of patients and hypotension or vasopressor use in 14.7%.

Conclusions:

• In a severe TBI patient population, propranolol was typically initiated after the first week and continued for approximately three weeks.
• Mortality approached 20%, and about a quarter of patients were discharged home on beta blockers.
• Findings provide insights into real-world propranolol use and outcomes in critically ill TBI patients.