• Aziz S Alali, Kaushik Mukherjee, Victoria A McCredie, Eyal Golan, Prakesh S Shah, James M Bardes, Susan E Hamblin, Elliott R Haut, James C Jackson, Kosar Khwaja, Nimitt J Patel, Satish R Raj, Laura D Wilson, Avery B Nathens, and Mayur B Patel.
• *Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada †Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA ‡Eastern Association for the Surgery of Trauma, Chicago, IL §Department of Critical Care, University Health Network, Toronto, ON, Canada ¶Division of Critical Care and Department of Medicine, Mackenzie Health, Toronto, ON, Canada ||Department of Pediatrics, University of Toronto, Toronto, ON, Canada **Department of Surgery, West Virginia University, Morgantown, WV ††Department of Surgery, USC+LAC, Los Angeles, CA ‡‡Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN §§Departments of Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ¶¶Division of Pulmonary and Critical Care Medicine and Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN ||||Research Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN ***Departments of Surgery and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada †††Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, OH ‡‡‡Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AL, Canada §§§Department of Communication Sciences and Disorders, Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK ¶¶¶Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN ||||||Department of Surgery, University of Toronto, Toronto, ON, Canada ****Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada ††††Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN ‡‡‡‡Surgical Service, General Surgery Section, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN.
• Ann. Surg. 2017 Dec 1; 266 (6): 952961952-961.

ObjectiveTo determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI).BackgroundThere 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.MethodsUsing 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).ResultsData 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.ConclusionsIn 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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