Preinjury Beta Blockers are Associated With Increased Mortality in Geriatric Trauma Patients
- 1 November 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 65 (5), 1016-1020
- https://doi.org/10.1097/ta.0b013e3181897eac
Abstract
Beta-blockade decreases mortality and morbidity in selected older patient populations undergoing noncardiac general surgery. We hypothesized that preinjury beta blockade would increase mortality in geriatric trauma patients, given beta-blockers inhibit patient's physiologic responses to hypovolemic shock. Patients older than 65 years admitted to a level I trauma center were identified by the trauma registry. Medical records were reviewed for demographic and injury information. Preinjury beta blockade was determined by review of nurse and pharmacy admission histories. Logistic regression was used to determine whether there was any correlation between mortality and the use of preinjury beta blockers. Separate models were developed based on the presence or the absence of head injury. Of the 1,598 patients older than 65 years admitted between 1996 and 2006, 1,479 met inclusion criteria. Primary reason for exclusion was lack of documentation. Two hundred seventy-three patients were taking beta blockers before their trauma, and 14.7% died before discharge. Mortality in patients not taking beta blockers was 13.4%. Mortality in patients with head injury was 25.9%, significantly associated with warfarin use (OR 2.5, 95% CI 1.3-4.8). In patients without head injury, preinjury beta blockade had a significant association with mortality (OR 2.1, 95% CI 1.1-4.3). Many factors associated with mortality in elderly trauma patients are similar to the younger patient population. Unique to this population are increased comorbidities and use of prescription medications. Beta blockers, one of these common medications, are associated with increased mortality in the elderly.Keywords
This publication has 25 references indexed in Scilit:
- Beta-Blocker Use is Associated With Improved Outcomes in Adult Trauma PatientsThe Journal of Trauma and Acute Care Surgery, 2007
- Beta-Blocker Exposure is Associated With Improved Survival After Severe Traumatic Brain InjuryThe Journal of Trauma and Acute Care Surgery, 2007
- ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and BiologyJournal of the American College of Cardiology, 2006
- Antihypertensive Medication Use Among US Adults With HypertensionCirculation, 2006
- Beta-Blocker Use Is Associated with Improved Outcomes in Adult Burn PatientsThe Journal of Trauma and Acute Care Surgery, 2004
- Effect of β-Blocking Therapy on Outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)Circulation, 2002
- Intracranial Complications of Preinjury Anticoagulation in Trauma Patients with Head InjuryThe Journal of Trauma and Acute Care Surgery, 2002
- Traumatic Rupture of the AortaAnnals of Surgery, 2002
- Blunt Thoracic Aortic InjuryThe Journal of Trauma and Acute Care Surgery, 1999
- The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart FailureThe New England Journal of Medicine, 1996