Department of General Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; University Medical Center-New Orleans, Norman E. McSwain-Spirit of Charity Level I Trauma Center.
INTRODUCTION: The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated.
METHODS: The trauma registry was queried for blunt head trauma patients from 2013-2017. Initial GCS (GCS-1) and toxicology screening from the database were reviewed. The next recorded GCS (GCS-2) from the neurosurgery consult note and the change in GCS (ΔGCS) was compared.
RESULTS: 468 patients were reviewed. 217 (46.4%) patients had no toxic substances found while 104 (22.2%) had more than one toxic substance. Alcohol level above the legal limit was in 109 (23.3%) of the patients, marijuana in 105 (22.4%), benzodiazepines in 94 (20.1%), opiates in 48 (10.3%), and cocaine in 41 (8.8%). The mean ΔGCS was significantly higher in impaired patients compared to those with a negative screening test (1.74 ± 2.4 vs 0.75 ± 2.7, p <.001). This is despite both groups having similar GCS-1 (6.23 ± 3.86 in the impaired group vs 6.47 ± 3.52 in the sober group, p =.677). There were 187 patients presented as a GCS 3 and 150 of those had a positive toxicology screen. The ΔGCS was significantly higher in the impaired group (2.75 ± 2.7 vs 1.19 ± 1.8, p<.001).
CONCLUSION: Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and any intoxicating substances should be reversed or allowed to wear off before GCS is recorded for benchmarking or quality reporting.