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

OBJECTIVES

The Eastern Association for the Surgery of Trauma guidelines conditionally recommend beta blockers for adults with traumatic brain injury (TBI); however, real-world utilization varies widely. This study describes critically ill patients with TBI who received propranolol during their hospitalization.

METHODS

This was a retrospective study evaluating patients 18 years or older admitted with TBI to the intensive care unit (ICU) at a level 1 trauma center between January 1, 2015, and April 30, 2023. Patients were identified using the institution's trauma registry and propranolol administration records. The primary outcome was to describe propranolol use in patients admitted with TBI. Secondary outcomes included in-hospital mortality, 28-day mortality, ICU and hospital length of stay, and discharge disposition. Safety outcomes included bradycardia, hypotension, or vasopressor use within 12 hours following propranolol administration.

RESULTS

A total of 217 patients were included. Most patients (95.9%) sustained blunt TBI, and the most common bleeding site was mixed (39.6%), followed by subdural (20.7%) and subarachnoid (20.7%). Beta blockers were initiated on average by day 8 with a mean duration of 22.9 days. In-hospital mortality was 18.9%, and 27.2% of patients were discharged to home or with home health. Bradycardia was observed in 40.1% of patients and hypotension or vasopressor use in 14.7%.

CONCLUSIONS

In a predominantly severe TBI patient population, most patients received propranolol after 1 week of admission for an average of 3 weeks. Mortality was close to 20% and approximately a quarter of patients were discharged home on a BB.