Beta-blockers for traumatic brain injury: a systematic review and meta-analysis.

Abstract

BACKGROUND\nParoxysmal sympathetic hyperactivity (PSH) and catecholamine surge, which are associated with poor outcome, may be triggered by traumatic brain injury (TBI). Beta adrenergic receptor blockers (β-blockers), as potential therapeutic agents to prevent PSH and catecholamine surge, have been shown to improve survival after TBI. The principal aim of this study was to investigate the effect of β-blockers on outcomes in patients with TBI.\n\n\nMETHODS\nFor this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and Cochrane Library databases from inception to September 25, 2020 for randomized controlled trials, nonrandomized controlled trials, and observational studies reporting the effect of β-blockers on the following outcomes after TBI: mortality, functional measures, and cardiopulmonary adverse effects of β-blockers (e.g. hypotension, bradycardia and bronchospasm). With use of random-effects model, we calculated pooled estimates, confidence intervals (CIs), and odds ratios (ORs) of all outcomes.\n\n\nRESULTS\nFifteen studies with 12721 patients were included. Exposure to β-blockers after TBI was associated with a significant reduction in adjusted in-hospital mortality (OR, 0.39; 95% CI, 0.30-0.51; I2 = 66.3% ; p < 0.001). β-blockers significantly improved the long-term (≥6months) functional outcome (OR, 1.75; 95% CI, 1.09-2.80; I2 = 0% ; p = 0.02). Statistically significant difference was not seen for cardiopulmonary adverse events (OR, 0.91; 95% CI, 0.55-1.50; I2 = 25.9% ; p = 0.702).\n\n\nCONCLUSIONS\nThis meta-analysis demonstrated that administration of β-blockers after TBI was safe and effective. Administration of β-blockers may therefore be suggested in the TBI care. However, more high-quality trials are needed to investigate the use of β-blockers in the management of TBI.\n\n\nLEVEL OF EVIDENCE\nSystematic review and meta-analysis, level III.