الفهرس 
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Abstract
Severe TBI is associated with PSH whish is characterized by catecholamine surge. β-Blockers can break this cycle by protecting β-receptor rich brain cells to decrease the cerebral oxygen demand, which may attenuate cerebral ischemia and secondary brain injury. In addition, β-blockers are beneficial to decrease hypermetabolism, lighten cardiac workload and ischemia, and lessen cerebral oxygen demand in head injury. A total of 400 patients with moderate to severe TBI were selected from Mansoura University Emergency Hospital (MUEH) to evaluate the effects of Propranolol on TBI patients. The studied patients were divided randomly and equally into 2 groups (n=200): Propranolol group received IV propranolol within 12 hours of injury and Control group who didn’t receive propranolol. Most of the studied patients in propranolol and control groups were males (83.5% vs. 79.5%) of middle age [(34.7 ± 9.6) vs. (33.9 ± 10.1) years old]. The most common mode of trauma was MVC; followed by RTA, struggle, and FFH in without significant differences between Propranolol and Control groups. The admission CT brain findings were closely approximated in both groups. The CT brain findings were ICH in 30% vs. 36%; followed by IVH in 34.5% vs. 29%, brain edema in 18.5% vs. 22%, SDH in 16.5% vs. 19.5%, EDH in 13% vs. 14.5%, SAH in 13% vs. 9%, and fracture base in 8.5% vs. 7% in Propranolol and control groups respectively. The admission clinical parameters including heart rate, systolic BP, head AIS and GCS were closely approximated in both groups. After exclusion of mild TBI, patients were classified into moderate TBI in 68.5% and 62.5%; and severe TBI in 31.5% and 37.5% respectively. While, the follow up clinical assessment parameters after 7 days of admission were of high significant statistical differences (P <0.001) and were much better in Propranolol group. The clinical outcome of the studied cases were obviously better in Propranolol group (P <0.05). The neurologic examination; according to GCS; was improved in 34% vs. 27.5%. The cardiac examination; according to ECG showed changes in 12% vs. 26.5% in Propranolol and control groups respectively. Also, the secondary outcome assessment parameters including ICU LOS, ward LOS, mechanical ventilation, ventilation periods, survival rate and unfavorable GOS were better in Propranolol group (P <0.05) than control group. Conclusion Early propranolol administration is associated with significant improvements in mortality in patients with moderate to sever traumatic brain injury , lower hospital resources use and better functional outcome. It appears clear that Beta blockers may play a significant role in the future management of TBI and PSH.