doi:10.1016/j.jemermed.2005.04.012 Original Contributions THE ASSOCIATION BETWEEN FIELD GLASGOW COMA SCALE SCORE AND OUTCOME IN PATIENTS UNDERGOING PARAMEDIC RAPID SEQUENCE INTUBATION Daniel P. Davis, MD,* Tyler F. Vadeboncoeur, MD,* Mel Ochs, MD,† Jennifer C. Poste,*‡ Gary M. Vilke, MD,* and David B. Hoyt, MD§ *Department of Emergency Medicine, University of California San Diego (UCSD), San Diego, California, †San Diego County Emergency Medical Services, San Diego, California, ‡John Muir College, University of California San Diego, La Jolla, California, and §Department of Surgery, Division of Trauma, University of California San Diego, San Diego, California Reprint Address: Daniel Davis, MD, Department of Emergency Medicine, 200 West Arbor Drive, #8676, San Diego, CA 92103-8676 e Abstract—Early intubation is standard for treating se- vere traumatic brain injury (TBI). Aeromedical crews and select paramedic agencies use rapid sequence intubation (RSI) to facilitate intubation after TBI, with Glasgow Coma Scale (GCS) score commonly used as a screening tool. To explore the association between paramedic GCS and out- come in patients with TBI undergoing prehospital RSI, paramedics prospectively enrolled adult major trauma vic- tims with GCS 3– 8 and clinical suspicion for head trauma to undergo succinylcholine-assisted intubation as part of the San Diego Paramedic RSI Trial. The following data were abstracted from paramedic debriefing interviews and the county trauma registry: demographics, mechanism, vi- tal signs including GCS score, clinical evidence of aspira- tion before RSI, arrival laboratory values, hospital course, and outcome. Paramedic GCS calculations were confirmed during debriefing interviews. Patients were stratified by GCS score, with chi-square and receiver-operator-curve (ROC) analysis used to explore the relationship between GCS and hypoxia, head injury severity, aspiration, inten- sive care unit (ICU) length of stay, and outcome. Cohort analysis was used to explore potential reasons for early extubation and discharge from the ICU in some patients. A total of 412 patients were included in this analysis. A total of 81 patients (20%) were extubated and discharged from the ICU in 48 h or less; these patients had higher pre-RSI oxygen saturation (SaO 2 ) values and higher arrival serum ethanol levels. Paramedic and physician GCS calculations had high agreement (kappa  0.995). A statistically signif- icant relationship was observed between GCS score and Head Abbreviated Injury Score (AIS), survival, and pre- RSI SaO 2 values. However, ROC analysis revealed a lim- ited ability of GCS to predict the presence of severe TBI, injury severity, desaturation, aspiration, ICU length of stay, or ultimate survival. In conclusion, paramedics seem to accurately calculate GCS values before prehospital RSI. Although a relationship between paramedic GCS and out- come exists, the ability to predict the severity of injury, airway-related complications, ICU length of stay, and over- all survival is limited using this single variable. Other fac- tors should be considered to screen TBI patients for pre- hospital RSI. © 2005 Elsevier Inc. e Keywords—Glasgow Coma Scale; paramedic; prehospi- tal; EMS; Rapid Sequence Intubation; traumatic brain injury; head trauma INTRODUCTION Secondary brain injury plays an important role in the outcome of patients with severe traumatic brain injury (TBI) (1–5). Early intubation of patients with traumatic Presented at the Society for Academic Emergency Medicine Annual Meeting, Orlando, Florida, May 2004. RECEIVED: 8 June 2004; FINAL SUBMISSION RECEIVED: 18 February 2005; ACCEPTED: 29 April 2005 The Journal of Emergency Medicine, Vol. 29, No. 4, pp. 391–397, 2005 Copyright © 2005 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/05 $–see front matter 391