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Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13

Published online by Cambridge University Press:  28 June 2012

Albert K. Hsiao ,
Stuart P. Michelson  and
Jerris R. Hedges
Albert K. Hsiao
Affiliation:
Oregon Health Sciences University, Department of Emergency Medicine, Portland, Oregon
Stuart P. Michelson
Affiliation:
Oregon Health Sciences University, Department of Emergency Medicine, Portland, Oregon
Jerris R. Hedges*
Affiliation:
Oregon Health Sciences University, Department of Emergency Medicine, Portland, Oregon
*
Oregon Health Sciences University, Department of Emergency Medicine, 3181 S. W. Sam Jackson Park Road, Portland, OR 97201-3098USA
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Abstract

Introduction:

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 ≤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 ≤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.

Conclusion:

Patients with a presenting GCS score of ≤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. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.

Keywords

computerized axial tomography (CT) scanemergency medical technician (EMT)emergency medical services (EMS)Glasgow Coma Scale (GCS) scorehemorrhageintubationmultiple injurypredictorstrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 3 , September 1993 , pp. 229 - 236
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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References

1. Ligier, B, Buchman, TG, Breslow, MJ, Deutschman, CS: The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims. Gynecol Obstet 1991;173:477–481.Google ScholarPubMed
2. Hedges, JR, Dronen, SC, Feero, S, et al. : Succinylcholine-assisted intubations in prehospital care. Ann Emerg Med 1988;17:[469–472.CrossRefGoogle ScholarPubMed
3. Teasdale, G, Jennett, B: Assessment of coma and impaired consciousness: A practical guide. Lancet 1974;2:81–84.CrossRefGoogle Scholar
4. Lowe, D, Pope, R, Hedges, JR: Time management study of trauma resuscitation. Am J Surg 1991;159:457–461.CrossRefGoogle Scholar
5. Champion, HR, Sacco, WJ, Copes, WS, et al. : A revision of the trauma score. J Trauma 1989;29:623–628.CrossRefGoogle ScholarPubMed
6. Baker, SP, O'Neill, B, Haddon, W, et al. : The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.CrossRefGoogle ScholarPubMed
7. American College of Surgeons: Advanced Trauma Life Support Program: Instructor Manual 1989.Google Scholar
8. Lowe, D, Hedges, JR, Marby, D, et al. : An assessment of time following trauma resuscitation: The transitional evaluation and monitoring phase. J Trauma 1991;31:1265–1269.CrossRefGoogle ScholarPubMed
9. Baxt, WG, Jones, G, Fortlage, D: The trauma triage rule: A new resource-based approach to the prehospital identification of major trauma victims. Ann Emerg Med 1990;19:1401–1406. EditorialCrossRefGoogle Scholar