Predictive Value of the Glasgow Coma Scale for Tracheotomy in Head-Injured Patients

Abstract

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating ≤7 than it is in patients with a GCS rating >7 (p= .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score ≤7 who do not undergo craniotomy and are otherwise stable.

Optimal timing of tracheostomy after trauma without associated head injury

“…For example, trauma patients with significant head or neck injuries often require tracheostomy for prolonged airway maintenance regardless of whether there is concomitant respiratory failure. This may facilitate the decision for tracheostomy placement earlier in the hospital course [30] and may also result in decreased duration of mechanical ventilation and faster recovery in this subpopulation [14,15]. In contrast, it is more difficult to predict the need for tracheostomy in trauma patients with prolonged respiratory failure without significant head or neck injuries.…”

Intracranial Pressure Monitoring During Percutaneous Tracheostomy “Percutwist” in Critically Ill Neurosurgery Patients

“…Percut aneous dilatational tracheostomy (PDT) is a safe procedure for airway management in critically ill patients requiring long-term ventilatory support. 1,2 In neurologically critically ill patients, tracheostomy carries a high risk of neurologic deterioration due to potential disturbances of neurophysiological, hemodynamic, and respiratory variables. 3,4 In fact, the pressure applied to the neck during the dilation maneuver can reduce jugular venous outflow, and the use of fiberoptic endoscopy, tube suctioning, and multiple dilators can lead to desaturation, hypoxia or hypercarbia, 5 which are deleterious in patients with impaired cerebral compensatory mechanisms.…”

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“…Lanza et al [ 59 ] retrospectively reviewed head injury patients to examine the predictive value of the GCS for tracheostomy in these patients. Of 47 patients divided according to their GCS rating, 34 had a GCS ≤ 7 and 13 had GCS > 7.…”