Impact of acute intoxication on the Glasgow coma scale scores of trauma patients

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS). Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC). Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed. Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same. Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

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The Relationship Between Out-of-Hospital Airway Management and Outcome Among Trauma Patients with Glasgow Coma Scale Scores of 8 or Less

Prehospital Emergency Care ◽

10.3109/10903127.2010.545473 ◽

2011 ◽

Vol 15 (2) ◽

pp. 184-192 ◽

Cited By ~ 40

Author(s):

Daniel P. Davis ◽

Kent M. Koprowicz ◽

Craig D. Newgard ◽

Mohamud Daya ◽

Eileen M. Bulger ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Airway Management ◽

Trauma Patients ◽

Coma Scale ◽

Scale Scores ◽

The Relationship

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408: Scene Glasgow Coma Scale Scores Can Help Predict Mortality in Pediatric Blunt Trauma

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2008.06.436 ◽

2008 ◽

Vol 52 (4) ◽

pp. S166

Author(s):

C.B. Irvin ◽

K.E. Duemling ◽

T. Oberg ◽

A.M. Ads

Keyword(s):

Glasgow Coma Scale ◽

Blunt Trauma ◽

Coma Scale ◽

Scale Scores

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Mortality by Decade in Trauma Patients with Glasgow Coma Scale 3

The American Surgeon ◽

10.1177/000313481107701015 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1342-1345 ◽

Cited By ~ 3

Author(s):

Eric J. Ley ◽

Morgan A. Clond ◽

Omar N. Hussain ◽

Marissa Srour ◽

James Mirocha ◽

...

Keyword(s):

Los Angeles ◽

Glasgow Coma Scale ◽

Trauma System ◽

Mortality Rates ◽

High Survival ◽

Trauma Patients ◽

Coma Scale ◽

The Third ◽

Aggressive Care ◽

Improvement In Survival

The aim of this study was to assess how increasing age affects mortality in trauma patients with Glasgow Coma Scale (GCS) 3. The Los Angeles County Trauma System Database was queried for all patients aged 20 to 99 years admitted with GCS 3. Mortality was 41.8 per cent for the 3306 GCS 3 patients. Mortality in the youngest patients reviewed, those in the third decade, was 43.5 per cent. After logistic regression analysis, patients in the third decade had similar mortality rates to patients in the sixth (adjusted OR, 0.88; CI, 0.68 to 1.14; P = 0.33) and seventh decades (adjusted OR, 0.96; CI, 0.70 to 1.31; P = 0.79). A significantly lower mortality rate, however, was noted in the fifth decade (adjusted OR, 0.76; CI, 0.61 to 0.95; P = 0.02). Conversely, significantly higher mortality rates were noted in the eighth (adjusted OR, 1.93; CI, 1.38 to 2.71; P = 0.0001) and combined ninth/tenth decades (adjusted OR, 2.47; CI, 1.71 to 3.57; P < 0.0001). Given the high survival in trauma patients with GCS 3 as well as continued improvement in survival compared with historical controls, aggressive care is indicated for patients who present to the emergency department with GCS 3.

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