Emergent intubation and CT scan pathology of blunt trauma patients with Glasgow Coma Scale scores of 3-13.
BACKGROUND
Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed.  Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).


METHODS
A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of less than or equal to 13 was performed.  A total of 120 patients met the inclusion and exclusion criteria.


RESULTS
A significant number of patients presenting with a GCS score of less than or equal to 9 required emergent intubation.  A significant minority of patients presenting with a GCS score of 10-13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.


CONCLUSIONS
Patients with a presenting GCS score of less than or equal to 9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs).  Emergent intubation of patients with a GCS score of 10-13 is problematic.  Patients with a presenting GCS score of 10-13 must be evaluated individually and closely monitored.(ABSTRACT TRUNCATED AT 250 WORDS)
Oregon Health Sciences University, Department of Emergency Medicine, Portland 97201.
A K
AK
Hsiao
S P
SP
Michelson
J R
JR
Hedges
D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000473:pathology; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers