Evidence map›Paper›PMID 28525411›Full record

GuidelineAnnals of surgery2017

Beta-blockers and Traumatic Brain Injury: A Systematic Review, Meta-analysis, and Eastern Association for the Surgery of Trauma Guideline.

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 and 5 more

Abstract readMeta-AnalysisSystematic ReviewPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Annals of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Aziz S Alali*Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada †Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA ‡Eastern Association for the Surgery of Trauma, Chicago, IL §Department of Critical Care, University Health Network, Toronto, ON, Canada ¶Division of Critical Care and Department of Medicine, Mackenzie Health, Toronto, ON, Canada ||Department of Pediatrics, University of Toronto, Toronto, ON, Canada **Department of Surgery, West Virginia University, Morgantown, WV ††Department of Surgery, USC+LAC, Los Angeles, CA ‡‡Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN §§Departments of Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ¶¶Division of Pulmonary and Critical Care Medicine and Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN ||||Research Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN ***Departments of Surgery and Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada †††Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, OH ‡‡‡Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AL, Canada §§§Department of Communication Sciences and Disorders, Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK ¶¶¶Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN ||||||Department of Surgery, University of Toronto, Toronto, ON, Canada ****Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada ††††Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN ‡‡‡‡Surgical Service, General Surgery Section, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN.
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

Funding

Vanderbilt Institute for Clinical and Translational Research (VICTR) -Identifying correlates of functional immunity in SARS-CoV-2 convalescent plasmaUL1TR002243 · NCATS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Paul A. Harris, Wesley H Self · 2017 to 2026
$130.7M
The Vanderbilt Institute for Clinical and Translational Research (VICTR)UL1TR000445 · NCATS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI BERNARD, GORDON RAPHAEL · 2012 to 2016
$41.4M
Altering Sedation Paradigms to Improve Brain Injury and Survival in Severe SepsisR01HL111111 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI PANDHARIPANDE, PRATIK · 2012 to 2017
$3.7M
The INSIGHT-ICU Study: Illuminating Neuropsychological dysfunction and Systemic Inflammatory mechanisms Gleaned after Hospitalization in Trauma-ICU StudyR01GM120484 · NIGMS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI PATEL, MAYUR B · 2017 to 2021
$3.0M
Individualized Performance Feedback on Venous Thromboembolism Prevention PracticeR01HS024547 · AHRQ · JOHNS HOPKINS UNIVERSITY · PI HAUT, ELLIOTT R · 2016 to 2020
$1.2M
AHRQ HHS R01 HS024547NCATS NIH HHS UL1 TR000445NCATS NIH HHS UL1 TR002243NHLBI NIH HHS R01 HL111111NIGMS NIH HHS R01 GM120484
6 · The paper itself

Abstract

objectiveTo determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI).

backgroundThere have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach.

methodsUsing MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g., hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I).

resultsData were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95% CI: 0.27-0.56; I = 65%, P < 0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified.

conclusionsIn adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

Indexed as

Adrenergic beta-AntagonistsBrain InjuriesBronchial SpasmCardiovascular DiseasesHospital MortalityHumansQuality of LifeTreatment OutcomeAdrenergic beta-Antagonists

Identifiers

PMID28525411
PMCPMC5997270

What OpenQuestion holds

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LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.