Use of Glasgow Coma Scale as an Indicator for Early Tracheostomy in Patients with Severe Head Injury

Early tracheostomy can reduce the time required for mechanical ventilation, the duration of ICU stay, and treatment expenses. Choosing the optimal time for tracheostomy in patients with severe head injury is therefore important. The purpose of this study was to find the optimal time for tracheostomy according to Glasgow Coma Scale (GCS). In this prospective study, patients with severe head injury (GCS<8) admitted to the ICU of Kerman Shahid Bahonar Hospital were evaluated every day according to their GCS, and possible need for tracheostomy. Seventy-four patients were enrolled. The GCS of 49 patients on day 5 following ICU admission was <9. Forty-two patients (85.7%) eventually needed tracheostomy, and tracheostomy was not required in the remainder (14.3%). The prevalence of tracheostomy in patients with GCS >9 was 50%, and this difference was statistically significant. The present study showed that GCS of patients with severe head injury on day 5 following ICU admission may be used for decision-making regarding the time of tracheostomy. Tracheostomy should be carried out on day 5 following ICU admission if the GCS is ≤8, but it can be delayed if the GCS on the 5th day is >9.