BACKGROUND: Increasing data indicate treatment with beta blockers might improve survival after traumatic brain injury (TBI); the optimal heart rate (HR) range for these patients is unknown. To guide treatment, admission HR in moderate to severe TBI patients was analyzed to determine if a specific range is associated with decreased mortality. METHODS: The Los Angeles County Trauma System Database, consisting of five Level I and 8 Level II trauma centers, was queried for all injured patients admitted between 1998 and 2005 (n = 147,788). Isolated moderate to severe TBI patients (head abbreviated injury score > or = 3) were then identified. Demographics and outcomes were compared at various admission HR subgroups (<50, 50-59, 60-69, 70-79, 80-89, 90-99, 100-109, > or =110). Logistic regression was then performed to determine predictors of mortality. RESULTS: After exclusions, a total of 11,977 isolated moderate to severe isolated TBI patients were analyzed, overall mortality was 11.5% with a trend toward lowest mortality at HR 80 to 89 (7.3%). Each HR subgroup had a significantly increased unadjusted odds ratio for mortality compared with HR 80 to 89, except HR 90 to 99 (OR 1.2, CI 1.0-1.5) and HR 100 to 109 (OR 1.2, CI 1.0-1.5). In multivariable logistic regression analysis, HR <50, 50-59, 60-69, and > or =110 were independent predictors for increased mortality compared with HR 80-89. CONCLUSION: After isolated moderate to severe TBI, HR <50, 50-59, 60-69, and > or =110 were independent predictors of increased mortality. HR outside the range 70-109 could serve as a marker for aggressive resuscitation. As mortality increased significantly with HR: <50 (AOR 4.70), 50-59 (AOR 2.21), and 60-69 (AOR 1.63), our findings recommend avoiding HR < 70 in patients with moderate to severe TBI. Copyright 2010 Elsevier Inc. All rights reserved.
BACKGROUND: Increasing data indicate treatment with beta blockers might improve survival after traumatic brain injury (TBI); the optimal heart rate (HR) range for these patients is unknown. To guide treatment, admission HR in moderate to severe TBIpatients was analyzed to determine if a specific range is associated with decreased mortality. METHODS: The Los Angeles County Trauma System Database, consisting of five Level I and 8 Level II trauma centers, was queried for all injured patients admitted between 1998 and 2005 (n = 147,788). Isolated moderate to severe TBIpatients (head abbreviated injury score > or = 3) were then identified. Demographics and outcomes were compared at various admission HR subgroups (<50, 50-59, 60-69, 70-79, 80-89, 90-99, 100-109, > or =110). Logistic regression was then performed to determine predictors of mortality. RESULTS: After exclusions, a total of 11,977 isolated moderate to severe isolated TBIpatients were analyzed, overall mortality was 11.5% with a trend toward lowest mortality at HR 80 to 89 (7.3%). Each HR subgroup had a significantly increased unadjusted odds ratio for mortality compared with HR 80 to 89, except HR 90 to 99 (OR 1.2, CI 1.0-1.5) and HR 100 to 109 (OR 1.2, CI 1.0-1.5). In multivariable logistic regression analysis, HR <50, 50-59, 60-69, and > or =110 were independent predictors for increased mortality compared with HR 80-89. CONCLUSION: After isolated moderate to severe TBI, HR <50, 50-59, 60-69, and > or =110 were independent predictors of increased mortality. HR outside the range 70-109 could serve as a marker for aggressive resuscitation. As mortality increased significantly with HR: <50 (AOR 4.70), 50-59 (AOR 2.21), and 60-69 (AOR 1.63), our findings recommend avoiding HR < 70 in patients with moderate to severe TBI. Copyright 2010 Elsevier Inc. All rights reserved.
Authors: 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; Mayur B Patel Journal: Ann Surg Date: 2017-12 Impact factor: 12.969
Authors: Brett E Larson; David W Stockwell; Stefan Boas; Trevor Andrews; George C Wellman; Warren Lockette; Kalev Freeman Journal: J Surg Res Date: 2011-10-24 Impact factor: 2.192
Authors: Alfonso J Lopez; Mohamed ElSaadani; Christina L Jacovides; Anastasia Georges; Matthew C Culkin; Syed Ahmed; Monisha A Kumar; Lewis J Kaplan; Douglas H Smith; Jose L Pascual Journal: J Trauma Acute Care Surg Date: 2022-01-18 Impact factor: 3.697
Authors: Thomas J Schroeppel; John P Sharpe; Charles Patrick Shahan; Lesley P Clement; Louis J Magnotti; Marilyn Lee; Michael Muhlbauer; Jordan A Weinberg; Elizabeth A Tolley; Martin A Croce; Timothy C Fabian Journal: Trauma Surg Acute Care Open Date: 2019-08-18