Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department.
BACKGROUND
Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone.


OBJECTIVE
A survey of all poisoned patients with a decreased GCS who were admitted to an ED short-stay ward staffed by experienced emergency physicians, to establish the incidence of clinically significant aspiration or other morbidities and endotracheal intubation.


METHODS
A prospective, observational study was conducted of all patients admitted to the ED short-stay ward with a decreased level of consciousness (GCS < 15).


RESULTS
The study included 73 patients with decreased consciousness as a result of drug or alcohol intoxication. The GCS ranged from 3 to 14, and 12 patients had a GCS of 8 or less. No patient with a GCS of 8 or less aspirated or required intubation. There was one patient who required intubation; this patient had a GCS of 12 on admission to the ward.


CONCLUSIONS
This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
Duncan
Russell
R
Department of Emergency Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Thakore
Shobhan
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000150:complications / Q000628:therapy; D062787:Drug Overdose / Q000150:complications / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000517:prevention & control*; D053608:Stupor / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult