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Background: β-Adrenergic receptor blockers (BBs) administered after trauma blunt the cascade of immune and inflammatory changes associated with injury. BBs are associated with improved outcomes after traumatic brain injury (TBI). Propranolol may be an ideal BB because of its nonselective inhibition and ability to cross the blood-brain barrier. We determined if early administration of propranolol after TBI is associated with lower mortality., Methods: All adults (age ≥ 18 years) with moderate-to-severe TBI (head Abbreviated Injury Scale [AIS] score, 3-5) requiring intensive care unit (ICU) admission at a Level I trauma center from January 1, 2013, to May 31, 2015, were prospectively entered into a database. Administration of early propranolol was dosed within 24 hours of admission at 1 mg intravenous every 6 hours. Patients who received early propranolol after TBI (EPAT) were compared with those who did not (non-EPAT). Data including demographics, hospital length of stay (LOS), ICU LOS, and mortality were collected., Results: Over 29 months, 440 patients with moderate-to-severe TBI met inclusion criteria. Early propranolol was administered to 25% (109 of 440) of the patients. The EPAT cohort was younger (49.6 years vs. 60.4 years, p < 0.001), had lower Glasgow Coma Scale (GCS) score (11.7 vs. 12.4, p = 0.003), had lower head AIS score (3.6 vs. 3.9, p = 0.001), had higher admission heart rate (95.8 beats/min vs. 88.4 beats/min, p = 0.002), and required more days on the ventilator (5.9 days vs. 2.6 days, p < 0.001). Similarities were noted in sex, Injury Severity Score (ISS), admission systolic blood pressure, hospital LOS, ICU LOS, and mortality rate. Multivariate regression showed that EPAT was independently associated with lower mortality (adjusted odds ratio, 0.25; p = 0.012)., Conclusion: After adjusting for predictors of mortality, early administration of propranolol after TBI was associated with improved survival. Future studies are needed to identify additional benefits and optimal dosing regimens., Level of Evidence: Therapeutic study, level IV.

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P<0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P<0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P<0.01) and had a significantly higher mortality (AOR, 1.12; P<0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.