Open AccessDoes Beta‐Blockade Reduce the Risk of Depression in Patients with Isolated Severe Extracranial Injuries?
Author(s) -
Ahl Rebecka,
Barmparas Galinos,
Riddez Louis,
Ley Eric J.,
Wallin Göran,
Ljungqvist Olle,
Mohseni Shahin
Publication year - 2017
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-017-3935-5
Subject(s) - medicine , glasgow coma scale , depression (economics) , traumatic brain injury , injury severity score , poison control , cohort , blockade , anesthesia , injury prevention , emergency medicine , psychiatry , receptor , economics , macroeconomics
Background Approximately half of trauma patients develop post‐traumatic depression. It is suggested that beta‐blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta‐blockade on depression following severe traumatic injuries in patients without significant brain injury. Methods Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In‐hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre‐admission beta‐blocker status. The primary outcome was post‐traumatic depression, defined as receiving antidepressants ≤1 year following trauma. Results Five hundred and ninety‐six patients met the inclusion criteria with 11.4% prescribed pre‐admission beta‐blockade. Patients receiving beta‐blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta‐blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta‐blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1–7.2, p = 0.04). After adjusting for group differences, patients lacking beta‐blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2–8.6, p = 0.02). Conclusions Pre‐admission beta‐blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta‐blockade in these instances.