Beta-blockers in adults with acute traumatic brain injury - a systematic review and meta-analysis of randomized controlled trials

Sep 30, 2026

Traumatic brain injury (TBI) causes major death and long-term disability worldwide, and secondary injury is driven in part by excessive sympathetic activation. This systematic review and meta-analysis evaluated randomized controlled trials testing beta-blockers in adults with acute TBI. MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov were searched. Primary focus was long-term functional outcome using GOS or GOS-E; secondary outcomes included mortality, ICU/hospital stay, ventilation duration, and adverse events.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

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Introduction

Bouras et al. JAnesthAnalg Crit Care (2026) 6:2 [https://doi.org/10.1186/s44158-025-00316-0](https://doi.org/10.1186/s44158-025-00316-0) Journal of Anesthesia, Analgesia and Critical Care REVIEW Open Access Beta-blockers in adults with acute traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials Marwan Bouras1,2,3†, Nicolas Beaulieu1†, Tomas HaygTorkomyan1, Sarah O’Connor1, Olivier Costerousse1, François Lauzier 1,2, Ryan Zarychanski4,5, Michael Verret1,2, Shane W. English6, Bourke Tillmann7, Ian Ball8, Marat Slessarev8, Alexis F. Turgeon 1,2* and Canadian Traumatic Brain Injury Research Consortium Abstract Background Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Beyond the primary insult, excessive sympathetic activation contributes to secondary brain injury and poor outcomes. Beta-blockers may attenuate this hyperadrenergic surge and provide neuroprotective benefits, but their efficacy in improving longterm functional recovery remains uncertain. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating beta-blockers in adults with acute TBI. We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials. gov for RCTs comparing beta-blockers with placebo, usual care, or non-adrenergic comparators. Our primary outcome was long-term functional outcome, assessed with the Glasgow Outcome Scale (GOS) or its Extended version (GOS-E) . Secondary outcomes included mortality, intensive care unit (ICU) and hospital length of stay, duration of mechanical ventilation, and adverse events. Results Seven RCTs (n = 559) met inclusion; six (n = 445) contributed data to meta-analyses. Only two trials (n = 259) reported functional outcomes. Beta-blockers did not significantly reduce the risk of unfavorable neurological outcome (RR 0 . 81; 95% CI 0 .57–1. 15; very low certainty) . In contrast, beta-blocker therapy was associated with a reduction in mortality (RR 0 . 57; 95% CI 0.39–0. 82; 6 trials, n = 440; low certainty) and a shorter duration of mechanical ventilation (–1 . 58 days; 95% CI –2.91 to –0 . 26; 2 trials, n = 85; low certainty) . No effect was observed on ICU or hospital stay. Adverse event reporting was sparse, but no consistent safety concerns were identified. Conclusions In adults with acute TBI, beta-blockers did not decrease unfavorable long-term neurological outcomes but were associated with lower mortality and shorter duration of mechanical ventilation. Given the small number of trials and very low certainty of evidence, definitive conclusions cannot be drawn, and routine use cannot be recommended. A large, well-designed RCT is needed to establish the efficacy and safety of beta-blockers in this population. †Marwan Bouras and Nicolas Beaulieu are co-primary authors. *Correspondence: Alexis F. Turgeon [alexis.turgeon@crchudequebec.ulaval.ca](alexis.turgeon@crchudequebec.ulaval.ca) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permi

FAQs

What was the primary outcome in this review?

The primary outcome was long-term functional outcome assessed using the Glasgow Outcome Scale (GOS) or GOS-E.

Did beta-blockers improve long-term neurological functional outcomes?

Beta-blockers did not significantly reduce the risk of unfavorable long-term neurological outcomes.

What benefits were associated with beta-blocker therapy despite limited functional evidence?

Beta-blocker therapy was associated with reduced mortality and a shorter duration of mechanical ventilation, with no observed effect on ICU or hospital length of stay.

Sep 30, 2026

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