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Identifying traumatic brain injury in patients with isolated head trauma: are arterial lactate and base deficit as helpful as in polytrauma?
  1. Shahriar Zehtabchi,
  2. Richard Sinert,
  3. Samara Soghoian,
  4. Yiju Liu,
  5. Kristin Carmody,
  6. Lekha Shah,
  7. Mridul Kumar,
  8. Michael Lucchesi
  1. Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
  1. Correspondence to:
 Dr S Zehtabchi
 Department of Emergency Medicine, State University of New York, Downstate Medical Center, Box 1228, 450 Clarkson Avenue, Brooklyn, NY 11203, USA; szehtabchi{at}


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).

Materials and methods: TBI was defined as Glasgow Coma Scale ⩽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 to1.4) 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.

Conclusion: Arterial BD and LAC are poor predictors of TBI in isolated head trauma.

  • AISS, Abbreviated Injury Severity Score
  • BD, base deficit
  • CNS, central nervous system
  • CSF, cerebrospinal fluid
  • ED, emergency department
  • GCS, Glasgow Coma Scale
  • IHI, isolated head injury
  • KCHC, Kings County Hospital Center
  • LAC, lactate
  • ROC, receiver operating characteristic
  • TBI, traumatic brain injury

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  • Competing interests: None.