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Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

医学 回顾性队列研究 优势比 重症监护室 倾向得分匹配 置信区间 急诊医学 混淆 创伤性脑损伤 队列研究 队列 β受体阻滞剂 重症监护医学 内科学 儿科 心力衰竭 精神科
作者
Margot Kelly-Hedrick,Sunny Yang Liu,Jordan Komisarow,Jordan Hatfield,Tetsu Ohnuma,Miriam M. Treggiari,Katharine Colton,Evangeline Arulraja,Monica S. Vavilala,Daniel T. Laskowitz,Joseph Mathew,Adrian F. Hernandez,Michael L. James,Karthik Raghunathan,Vijay Krishnamoorthy
出处
期刊:Journal of Intensive Care Medicine [SAGE]
标识
DOI:10.1177/08850666241236724
摘要

There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking.The present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI.We conducted a retrospective cohort study of the administrative claims Premier Healthcare Database of adults (≥17 years) with moderate-severe TBI admitted to the intensive care unit (ICU) from 2016 to 2020. The exposure was receipt of a beta-blocker during day 1 or 2 of ICU stay (BB+). The primary outcome was hospital mortality, and secondary outcomes were: hospital length of stay (LOS), ICU LOS, discharge to home, and vasopressor utilization. In a sensitivity analysis, we explored the association of beta-blocker class (cardioselective and noncardioselective) with hospital mortality. We used propensity weighting methods to address possible confounding by treatment indication.A total of 109 665 participants met inclusion criteria and 39% (n = 42 489) were exposed to beta-blockers during the first 2 days of hospitalization. Of those, 42% received cardioselective only, 43% received noncardioselective only, and 14% received both. After adjustment, there was no association with hospital mortality in the BB+ group compared to the BB- group (adjusted odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.94, 1.04). The BB+ group had longer hospital stays, lower chance of discharged home, and lower risk of vasopressor utilization, although these difference were clinically small. Beta-blocker class was not associated with hospital mortality.In this retrospective cohort study, we found variation in use of beta-blockers and early exposure was not associated with hospital mortality. Further research is necessary to understand the optimal type, dose, and timing of beta-blockers for this population.
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