What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?

Resuscitation. 2012 Jan;83(1):86-9. doi: 10.1016/j.resuscitation.2011.07.017. Epub 2011 Jul 23.


Aim: To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care.

Method: Prospective observational study of adult patients requiring treatment in the trauma or resuscitation rooms of the Emergency Department, Prince of Wales Hospital, Hong Kong. A long cotton bud to stimulate the posterior pharyngeal wall (gag reflex) and a soft tracheal suction catheter were introduced through the mouth to stimulate the laryngopharynx and elicit the cough reflex. Reflexes were classified as normal, attenuated or absent.

Results: A total of 208 patients were recruited. Reduced gag and cough reflexes were found to be significantly related to reduced GCS (p=0.014 and 0.002, respectively). Of 33 patients with a GCS≤8, 12 (36.4%) had normal gag reflexes and 8 (24.2%) had normal cough reflexes. 23/62 (37.1%) patients with a GCS of 9-14 had absent gag reflexes, and 27 (43.5%) had absent cough reflexes. In patients with a normal GCS, 22.1% (25/113) had absent gag reflexes and 25.7% (29) had absent cough reflexes.

Conclusions: Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asian People*
  • Coma / classification*
  • Coma / ethnology
  • Coma / physiopathology
  • Cough / ethnology
  • Cough / physiopathology*
  • Critical Illness / epidemiology
  • Critical Illness / therapy*
  • Emergency Service, Hospital*
  • Female
  • Follow-Up Studies
  • Gagging / physiology
  • Glasgow Coma Scale / statistics & numerical data*
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Reflex / physiology*
  • Resuscitation / methods