{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:23:29Z","timestamp":1790029409913,"version":"4.0.1"},"reference-count":14,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T00:00:00Z","timestamp":1690588800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the ACS-TQIP-Participant Use File (PUF) 2015-2019 for adult trauma patients 18\u00a0years 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In patients with a GCS \u22645, there were no differences in mortality (GCS \u22645: 26.3% vs GCS &gt;5: 28.3%, adjusted P = .08), complication rates (GCS \u22645: 9.1% vs GCS &gt;5: 10.3%, adjusted P = .91), or ICU length of stay (GCS \u22645: 5.4 vs GCS &gt;5: 4.7, adjusted P = .36) between intubated and non-intubated patients. Intubated patients at GCS thresholds \u22648 (26.2% vs 19.1%, adjusted P &lt; .0001) and \u226410 (25.6% vs 15.8%, adjusted P &lt; .0001) had significantly higher mortality rates than non-intubated patients. Intubation at all GCS thresholds &gt;5 resulted in higher rates of complications, H-LOS, and ICU-LOS when compared to non-intubated patients with the same GCS score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A GCS \u22645 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348231192062","type":"journal-article","created":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T07:30:03Z","timestamp":1690615803000},"page":"6098-6113","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Glasgow Coma Scale Intubation Thresholds and Outcomes of Patients With Traumatic Brain Injury: The Need for Tailored Practice Management Guidelines"],"prefix":"10.1177","volume":"89","author":[{"given":"Adel","family":"Elkbuli","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA"},{"name":"Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Breeding","sequence":"additional","affiliation":[{"name":"NOVA Southeastern University, Fort Lauderdale, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah","family":"Ngatuvai","sequence":"additional","affiliation":[{"name":"NOVA Southeastern University, Fort Lauderdale, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heli","family":"Patel","sequence":"additional","affiliation":[{"name":"NOVA Southeastern University, Fort Lauderdale, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Andrade","sequence":"additional","affiliation":[{"name":"School of Osteopathic Medicine, A.T. Still University, Mesa, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Rosander","sequence":"additional","affiliation":[{"name":"Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Knowlton","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Surgical Critical Care, Stanford University Medical Center, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huazhi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Surgical Critical Care, Ocala Regional Medical Center, Ocala, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darwin","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Trauma and Surgical Critical Care, Ocala Regional Medical Center, Ocala, FL, USA"},{"name":"Department of Surgery, University of South Florida, Tampa, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,29]]},"reference":[{"key":"bibr1-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.067"},{"key":"bibr2-00031348231192062","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"bibr3-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-020-01383-4"},{"key":"bibr4-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2009.0940"},{"key":"bibr5-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199302000-00006"},{"key":"bibr6-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827018a5"},{"issue":"6","key":"bibr7-00031348231192062","first-page":"1305","volume":"68","author":"Muakkassa FF","year":"2010","journal-title":"J Trauma"},{"key":"bibr8-00031348231192062","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2015.68.3.213"},{"key":"bibr9-00031348231192062","volume-title":"Trauma Quality Programs Participant Use File","year":"2022"},{"key":"bibr10-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003123"},{"key":"bibr11-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15361"},{"key":"bibr12-00031348231192062","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12597"},{"key":"bibr13-00031348231192062","volume-title":"Advanced Trauma Life Support: ATLS Student Course Manual","volume":"13","author":"American College of Surgeons","year":"2012"},{"key":"bibr14-00031348231192062","doi-asserted-by":"publisher","DOI":"10.4103\/ija.ija_919_21"}],"updated-by":[{"DOI":"10.1177\/00031348241305412","type":"expression_of_concern","label":"Expression of concern","source":"publisher","updated":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000}}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231192062","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348231192062","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231192062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:24Z","timestamp":1777379904000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348231192062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,29]]},"references-count":14,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1177\/00031348231192062"],"URL":"https:\/\/doi.org\/10.1177\/00031348231192062","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,29]]}}}