Identifying traumatic brain injury in patients with isolated head trauma: are arterial lactate and base deficit as helpful as in polytrauma?
BACKGROUND
Increase in lactate (LAC) within the central nervous system after head trauma is an established marker of traumatic brain injury (TBI).


OBJECTIVE
To investigate the utility of arterial base deficit (BD) and LAC in identifying TBI in patients with isolated head injury (IHI).


METHODS
TBI was defined as Glasgow Coma Scale < or =8, head Abbreviated Injury Severity Score >2 or brain haematoma on CT scan. Patients were divided into two groups: IHI with and without TBI. Data were reported as means (SDs). 131 patients with IHI were studied (mean (SD) age 39 (19) years, 78% male).


RESULTS
17% of the patients sustained TBI. The mean differences for arterial BD (0.65 mmol/l, 95% CI -0.8 to 2.1) and LAC (0.34 mmol/l, 95% CI -0.7 to 1.4) in patients with and without TBI were not significant. Analysis of receiver operating characteristic curves confirmed that arterial BD and LAC were unable to detect TBI in patients with IHI.


CONCLUSIONS
Arterial BD and LAC are poor predictors of TBI in isolated head trauma.
Zehtabchi
Shahriar
S
Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. szehtabchi@yahoo.com
Sinert
Richard
R
Soghoian
Samara
S
Liu
Yiju
Y
Carmody
Kristin
K
Shah
Lekha
L
Kumar
Mridul
M
Lucchesi
Michael
M
D000137:Acid-Base Imbalance / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve
D015415:Biomarkers; D019344:Lactic Acid