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

This article examines the optimal Glasgow Coma Scale (GCS) threshold for endotracheal intubation (ETI) in adult patients with traumatic brain injury (TBI) presenting to emergency departments, using data from the American College of Surgeons Trauma Quality Program (ACS-TQIP) from 2015 to 2019. The study found that intubation at a GCS threshold of ≤ 5 did not increase mortality or complication rates compared to non-intubated patients and was associated with better discharge disposition, whereas intubation at thresholds of ≤ 8 and ≤ 10 was linked to significantly higher mortality, complications, and longer hospital and ICU stays. These findings challenge current guidelines, such as those from the Eastern Association for the Surgery of Trauma (EAST), which recommend intubation at GCS ≤ 8, suggesting that a lower threshold of GCS ≤ 5 may be safer and more beneficial. The authors recommend revisiting existing practice management guidelines and call for prospective randomized trials to further evaluate intubation thresholds in TBI care.