{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:03:38Z","timestamp":1787771018502,"version":"build-2784847793"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003509","name":"\u00d6rebro University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003509","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Scand J Trauma Resusc Emerg Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS)\u2009\u2265\u200916 with Abbreviated Injury Score of\u2009\u2264\u20092 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar\u2019s or paired Student\u2019s t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt\u00a0force trauma (88.5%) with a mean\u00a0[standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) as were cardiac complications (8.2% vs. 1.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.690) or in-hospital complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13049-021-00947-6","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T08:03:03Z","timestamp":1631088183000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Beta-blockade is not associated with improved outcomes in isolated severe extracranial injury: an observational cohort study"],"prefix":"10.1186","volume":"29","author":[{"given":"Lin","family":"Sadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Sj\u00f6lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7930-3845","authenticated-orcid":false,"given":"Rebecka","family":"Ahl Hulme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"issue":"3","key":"947_CR1","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1016\/j.jamcollsurg.2007.10.005","volume":"206","author":"K Inaba","year":"2008","unstructured":"Inaba K, Teixeira PG, David JS, Chan LS, Salim A, Brown C, et al. Beta-blockers in isolated blunt head injury. J Am Coll Surg. 2008;206(3):432\u20138.","journal-title":"J Am Coll Surg"},{"issue":"1","key":"947_CR2","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1097\/TA.0b013e31802d972b","volume":"62","author":"S Arbabi","year":"2007","unstructured":"Arbabi S, Campio EM, Hemmila MR, Barker M, Dimo M, Ahrns KS, et al. Beta-blocker use is associated with improved outcomes in adult trauma patients. J Trauma Acute Care Surg. 2007;62(1):56\u201361.","journal-title":"J Trauma Acute Care Surg"},{"key":"947_CR3","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1097\/TA.0000000000000139","volume":"76","author":"S Mohseni","year":"2015","unstructured":"Mohseni S, Talving P, Thelin EP, Wallin G, Ljungqvist O, Riddez L. The effect of \u03b2-blockade on survival after isolated severe traumatic brain injury. J Trauma Acute Care Surg. 2015;76:804\u20138.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"947_CR4","first-page":"804","volume":"76","author":"S Mohseni","year":"2014","unstructured":"Mohseni S, Talving P, Wallin G, Ljungqvist O, Riddez L. Preinjury \u03b2-blockade is protective in isolated severe traumatic brain injury. World J Surg. 2014;76(3):804\u20138.","journal-title":"World J Surg"},{"issue":"1","key":"947_CR5","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/TA.0b013e31802d02d0","volume":"62","author":"BA Cotton","year":"2007","unstructured":"Cotton BA, Snodgrass KB, Fleming SB, Carpenter RO, Kemp CD, Arbogast PG, et al. Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma Acute Care Surg. 2007;62(1):26\u201333.","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"947_CR6","first-page":"776","volume":"69","author":"TJ Schroeppel","year":"2010","unstructured":"Schroeppel TJ, Fischer PE, Zarzaur BL, Magnotti LJ, Clement PL, Fabian TC, et al. Beta-adrenergic blockade and traumatic brain injury: protective? J Trauma. 2010;69(4):776\u201382.","journal-title":"J Trauma"},{"issue":"2","key":"947_CR7","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1097\/TA.0000000000000104","volume":"76","author":"TJ Schroeppel","year":"2014","unstructured":"Schroeppel TJ, Sharpe JP, Magnotti LJ, Weinberg JA, Clement LP, Croce MA, et al. Traumatic brain injury and beta-blockers: not all drugs are created equal. J Trauma Acute Care Surg. 2014;76(2):504\u20139.","journal-title":"J Trauma Acute Care Surg"},{"key":"947_CR8","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1056\/NEJM199612053352301","volume":"335","author":"DT Mangano","year":"1996","unstructured":"Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery: Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335:1713\u201320.","journal-title":"N Engl J Med"},{"key":"947_CR9","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/00000542-199801000-00005","volume":"88","author":"A Wallace","year":"1998","unstructured":"Wallace A, Layug B, Tateo I, Li J, Hollenberg M, Browner W, et al. Prophylactic atenolol reduces postoperative myocardial ischemia: McSPI Research Group. Anesthesiology. 1998;88:7\u201317.","journal-title":"Anesthesiology"},{"issue":"1","key":"947_CR10","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1093\/bja\/85.1.109","volume":"85","author":"JP Desborough","year":"2000","unstructured":"Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109\u201317.","journal-title":"Br J Anaesth"},{"issue":"2","key":"947_CR11","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.surg.2008.09.013","volume":"145","author":"J Rough","year":"2009","unstructured":"Rough J, Engdahl R, Opperman K, Yerrum S, Monroy MA, Daly JM. B2 Adrenoreceptor blockade attenuates the hyperinflammatory response induced by traumatic injury. Surgery. 2009;145(2):235\u201342.","journal-title":"Surgery"},{"issue":"2","key":"947_CR12","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/TA.0b013e31821e0f93","volume":"72","author":"PI Johansson","year":"2012","unstructured":"Johansson PI, Stensballe J, Rasmussen LS, Ostrowski SR. High circulating adrenaline levels at admission predict increased mortality after trauma. J Trauma Acute Care Surg. 2012;72(2):428\u201336.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"947_CR13","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1152\/ajplegacy.1958.194.3.590","volume":"194","author":"HM Maling","year":"1958","unstructured":"Maling HM, Highman B. Exaggerated ventricular arrhythmias and myocardial fatty changes after large doses of norepinephrine and epinephrine in unanesthetized dogs. Am J Physiol. 1958;194(3):590\u20136.","journal-title":"Am J Physiol"},{"issue":"7","key":"947_CR14","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1038\/nm0798-808","volume":"4","author":"C Woiciechowsky","year":"1998","unstructured":"Woiciechowsky C, Asadullah K, Nestler D, Eberhardt B, Platzer C, Sch\u00f6ning B, et al. Sympathetic activation triggers systemic interleukin-10 release in immunodepression induced by brain injury. Nat Med. 1998;4(7):808\u201313.","journal-title":"Nat Med"},{"issue":"2\u20133","key":"947_CR15","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/S0014-2999(97)01569-0","volume":"344","author":"P Poulat","year":"1998","unstructured":"Poulat P, Couture R. Increased pulmonary vascular permeability and oedema induced by intrathecally injected endothelins in rat. Eur J Pharmacol. 1998;344(2\u20133):251\u20139.","journal-title":"Eur J Pharmacol"},{"issue":"5534","key":"947_CR16","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1038\/258437a0","volume":"258","author":"RW Alexander","year":"1975","unstructured":"Alexander RW, Davis JN, Lefkowitz RJ. Direct identification and characterisation of beta-adrenergic receptors in rat brain. Nature. 1975;258(5534):437\u201340.","journal-title":"Nature"},{"issue":"2","key":"947_CR17","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1152\/ajplegacy.1976.231.2.489","volume":"231","author":"ET MacKenzie","year":"1976","unstructured":"MacKenzie ET, McCulloch J, Harper AM. Influence of endogenous norepinephrine on cerebral blood flow and metabolism. Am J Physiol. 1976;231(2):489\u201394.","journal-title":"Am J Physiol"},{"issue":"9","key":"947_CR18","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1177\/000313480807400921","volume":"74","author":"CD Kemp","year":"2008","unstructured":"Kemp CD, Johnson JC, Riordan WP, Cotton BA. How we die: the impact of nonneurologic organ dysfunction after severe traumatic brain injury. Am Surg. 2008;74(9):866\u201372.","journal-title":"Am Surg"},{"issue":"3","key":"947_CR19","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1097\/01.CCM.0000155911.01844.54","volume":"33","author":"DA Zygun","year":"2005","unstructured":"Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ. Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med. 2005;33(3):654\u201360.","journal-title":"Crit Care Med"},{"issue":"1","key":"947_CR20","first-page":"46","volume":"64","author":"A Salim","year":"2008","unstructured":"Salim A, Hadjuzacharia P, Brown C, Inaba K, Teixeira PG, Chan L, et al. Significance of troponin elevation after severe traumatic brain injury. J Trauma. 2008;64(1):46\u201352.","journal-title":"J Trauma"},{"issue":"5","key":"947_CR21","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.amjsurg.2012.02.007","volume":"204","author":"M Bukur","year":"2021","unstructured":"Bukur M, Lustenberger T, Cotton B, Arbabi S, Talving P, Salim A, et al. Beta-blocker exposure in the absence of significant head injuries is associated with reduced mortality in critically ill patients. Am J Surg. 2021;204(5):697\u2013703.","journal-title":"Am J Surg"},{"issue":"4","key":"947_CR22","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1007\/BF01708961","volume":"20","author":"B Asgeirsson","year":"1994","unstructured":"Asgeirsson B, Grande PO, Nordstrom CH. A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med. 1994;20(4):260\u20137.","journal-title":"Intensive Care Med"},{"issue":"11","key":"947_CR23","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1097\/00003246-199811000-00033","volume":"26","author":"C Eker","year":"1998","unstructured":"Eker C, Asgeirsson B, Grande PO, Schalen W, Nordstrom CH. Improved outcome after severe head injury with a new therapy based on principles for brain volume regulation and preserved microcirculation. Crit Care Med. 1998;26(11):1881\u20136.","journal-title":"Crit Care Med"},{"key":"947_CR24","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/TA.0b013e31819388be","volume":"66","author":"EJ Ley","year":"2009","unstructured":"Ley EJ, Scehnet J, Park R, Schroff S, Dagliyan G, Conti PS, et al. The in vivo effect of propranolol on cerebral perfusion and hypoxia after traumatic brain injury. J Trauma Acute Care Surg. 2009;66:154\u20139.","journal-title":"J Trauma Acute Care Surg"},{"key":"947_CR25","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.ijcard.2004.11.025","volume":"105","author":"RM Ismailov","year":"2005","unstructured":"Ismailov RM, Ness RB, Weiss HB, Lawrence BA, Miller TR. Trauma associated with acute myocardial infarction in a multi-state hospitalized population. Int J Cardiol. 2005;105:141\u20136.","journal-title":"Int J Cardiol"},{"key":"947_CR26","unstructured":"Barron KW, Beesley RC, Benyajati S, Blair RW, Dormer KJ, Farber JP, et al. Basic Sciences Review for Medical Licensure. 4th ed. Thies R, editor. New York: Springer; 1995."},{"key":"947_CR27","doi-asserted-by":"crossref","unstructured":"Krepska A, Hastings J, Roodenburg O. The metabolic and endocrine response to trauma. Anaesthesia & Intesive Care Medicine. 2020. (in press).","DOI":"10.1016\/j.mpaic.2020.04.011"},{"issue":"6","key":"947_CR28","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1177\/1753425908100016","volume":"14","author":"SB Floh\u00e9","year":"2008","unstructured":"Floh\u00e9 SB, Floh\u00e9 S, Schade UF. Deterioration of the immune system after trauma: signals and cellular mechanisms. Innate Immun. 2008;14(6):333\u201344.","journal-title":"Innate Immun"},{"issue":"1","key":"947_CR29","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13054-017-1605-5","volume":"21","author":"PI Johansson","year":"2017","unstructured":"Johansson PI, Stensballe J, Ostrowski SR. Shock induced endotheliopathy (SHINE) in acute critical illness\u2014a unifying pathophysiologic mechanism. Crit Care. 2017;21(1):25\u201331.","journal-title":"Crit Care"},{"key":"947_CR30","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1177\/000313481608200721","volume":"82","author":"LE Hendrick","year":"2016","unstructured":"Hendrick LE, Schroeppel TJ, Sharpe JP, Alsbrook D, Magnotti L, Weinberg JA, et al. Impact of beta-blockers on nonhead injured trauma patients. Am Surg. 2016;82:575\u20139.","journal-title":"Am Surg"},{"key":"947_CR31","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1002\/bjs5.83","volume":"2","author":"M Eriksson","year":"2018","unstructured":"Eriksson M, Von Oelreich E, Brattstr\u00f6m O, Eriksson J, Larsson E, Oldner A. Effect of preadmission beta-blockade on mortality in multiple trauma. BJS Open. 2018;2:392\u20139.","journal-title":"BJS Open"},{"key":"947_CR32","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1097\/TA.0b013e3181897eac","volume":"65","author":"T Neideen","year":"2008","unstructured":"Neideen T, Lam M, Brasel KJ. Preinjury beta blockers are associated with increased mortality in trauma patients. J Trauma Acute Care Surg. 2008;65:1016\u201320.","journal-title":"J Trauma Acute Care Surg"},{"key":"947_CR33","doi-asserted-by":"publisher","first-page":"305","DOI":"10.4103\/0974-2700.142766","volume":"7","author":"DC Evans","year":"2014","unstructured":"Evans DC, Khoo KM, Radulescu A, Cook CH, Gerlach AT, Papadimos TJ, et al. Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients. J Emerg Trauma Shock. 2014;7:305\u20139.","journal-title":"J Emerg Trauma Shock"},{"key":"947_CR34","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1097\/TA.0b013e3181d8941d","volume":"69","author":"VA Ferraris","year":"2010","unstructured":"Ferraris VA, Ferraris SP, Saha SP. The relationship between mortality and preexisting cardiac disease in 5971 trauma patients. J Trauma Acute Care Surg. 2010;69:645\u201352.","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-021-00947-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13049-021-00947-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-021-00947-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T08:17:33Z","timestamp":1631089053000},"score":1,"resource":{"primary":{"URL":"https:\/\/sjtrem.biomedcentral.com\/articles\/10.1186\/s13049-021-00947-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,8]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["947"],"URL":"https:\/\/doi.org\/10.1186\/s13049-021-00947-6","relation":{},"ISSN":["1757-7241"],"issn-type":[{"value":"1757-7241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,8]]},"assertion":[{"value":"21 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was granted by the regional ethics review board in Stockholm (reference number 2015\/961-31\/4) and the hospital trauma committee of Karolinska University Hospital. Additional consent to participate was not sought due to existing consent of the utilised trauma registry. This was approved by the ethics review board.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}