Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department

J Emerg Med. 2009 Nov;37(4):451-5. doi: 10.1016/j.jemermed.2008.11.026. Epub 2009 Mar 9.


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.

Study 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alcoholic Intoxication / complications
  • Alcoholic Intoxication / therapy
  • Drug Overdose / complications
  • Drug Overdose / therapy
  • Emergency Service, Hospital*
  • Female
  • Glasgow Coma Scale*
  • Humans
  • Intubation, Intratracheal*
  • Male
  • Middle Aged
  • Patient Selection
  • Prospective Studies
  • Respiratory Aspiration / prevention & control*
  • Stupor / diagnosis
  • Stupor / etiology
  • Stupor / therapy*
  • Young Adult