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. 2023 Dec;89(12):6098-6113.
doi: 10.1177/00031348231192062. Epub 2023 Jul 29.

Glasgow Coma Scale Intubation Thresholds and Outcomes of Patients With Traumatic Brain Injury: The Need for Tailored Practice Management Guidelines

Adel Elkbuli  1   2 , Tessa Breeding  3 , Micah Ngatuvai  3 , Heli Patel  3 , Ryan Andrade  4 , Abigail Rosander  5 , Lisa M Knowlton  6 , Huazhi Liu  7 , Darwin Ang  7   8
Affiliations

Glasgow Coma Scale Intubation Thresholds and Outcomes of Patients With Traumatic Brain Injury: The Need for Tailored Practice Management Guidelines

Adel Elkbuli et al. Am Surg. 2023 Dec.

Expression of concern in

  • Expression of Concern.
    [No authors listed] [No authors listed] Am Surg. 2025 Mar;91(3):464-472. doi: 10.1177/00031348241305412. Epub 2025 Jan 10. Am Surg. 2025. PMID: 39791244 Free PMC article. No abstract available.

Abstract

Introduction: This study aims to re-evaluate the GCS threshold for intubation in patients presenting to the ED with a traumatic brain injury to optimize outcomes and provide evidence for future practice management guidelines.

Methods: We retrospectively reviewed the ACS-TQIP-Participant Use File (PUF) 2015-2019 for adult trauma patients 18 years and older who experienced a blunt traumatic head injury and received computerized tomography. Multivariable regressions were performed to assess associations between outcomes and GCS intubation thresholds of 5, 8, and 10.

Results: In patients with a GCS ≤5, there were no differences in mortality (GCS ≤5: 26.3% vs GCS >5: 28.3%, adjusted P = .08), complication rates (GCS ≤5: 9.1% vs GCS >5: 10.3%, adjusted P = .91), or ICU length of stay (GCS ≤5: 5.4 vs GCS >5: 4.7, adjusted P = .36) between intubated and non-intubated patients. Intubated patients at GCS thresholds ≤8 (26.2% vs 19.1%, adjusted P < .0001) and ≤10 (25.6% vs 15.8%, adjusted P < .0001) had significantly higher mortality rates than non-intubated patients. Intubation at all GCS thresholds >5 resulted in higher rates of complications, H-LOS, and ICU-LOS when compared to non-intubated patients with the same GCS score.

Conclusion: A GCS ≤5 was the threshold at which intubation in TBI patients conferred an additional benefit in disposition without worsened outcomes of mortality, H-LOS, or ICU-LOS. Trauma societies and hospital institutions should consider revisiting existing guidelines and protocols concerning the appropriate GCS threshold for safer intubation and better outcomes among these patient population.

Keywords: Glasgow Coma Scale; intubation threshold; practice management guidelines; trauma outcomes; traumatic brain injury.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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