Traumatic Brain Injury: Test and Diagnosis

1st order laboratory parameters – obligatory laboratory tests.

  • Small blood count
  • Inflammatory parameters – CRP (C-reactive protein).
  • Fasting glucose (fasting blood sugar)
  • Blood gas analysis (BGA)
  • Thyroid parameters – TSH
  • Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT).
  • Renal parameters – urea, creatinine, creatinine clearance if necessary.
  • Coagulation parameters – PTT, Quick
  • Alcohol level
  • Blood type
  • Blood tests to detect brain injury (if available):
    • Detection of the proteins UCH-L1 (“Ubiquitin Carboxy-terminal Hydrolase-L1”) and GFAP (“Glial Fibrilliary Acidic Protein”) – the test was nevaluated in an international study of 1,947 patients who had suffered a mild to moderate disorder of consciousness (Glasgow Coma Scale 9 to 15):
      • Testing was performed 3-12 hours after injury and 97.5% predicted whether lesions were later seen on CT (sensitivity). Negative CT was 99.6% predictive (negative predictive value). CONCLUSION: These results demonstrate that the test can reliably predict the absence of intracranial lesions.
    • S100B test – prognostic marker after cerebral injury (apoplexy, traumatic brain injury) or neurodegeneration; if positive within 4 hours after accident → cranial computed tomography (cCT) recommendedNote: False-positive, i.e., elevated above the threshold of 0.1 ng/ml, after competitive sports, fractures, and neurological disease.

Laboratory parameters 2nd order – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification.