Correlation between GCS and the risk of aspiration pneumonia in self-poisoning patients

Introduction

Self-poisoning is a common cause of nontraumatic coma, especially in young people. The management of these patients aims to protect the airway in order to prevent aspiration pneumonia (AP). Some author recommend to intubate when GCS < 8. However, only few studies have examined the relation between GCS, the caught reflex and the frequency of AP in self-poisoning patients (SPP). The aim of our study is to evaluate the relation between GCS and the risk of developing this complication.

Materials and methods

We conducted a retrospective study during 2004 including all admitted SPP in our ICU. GCS was noted on admission or immediately before intubation. The diagnosis of AP was performed according to the usual criteria. Two groups were compared: G1 (without AP) and G2 (with AP). Data were expressed as a mean ± SD and percentage. Tests used for comparisons were the Q square and Student t tests. The ROC curve was used to determinate the cutoff value of GCS associated to high risk of AP.

Results

Five hundred and twenty-four SPP were included. Seventy-eight (14.9%) had developed AP. The characteristic of the two groups are presented in Table 1. GCS was significantly lower in G2. The cutoff value on the ROC curve was 12 with a sensitivity of 86%, a specificity of 70% and an area under the curve of 0.816.

Table 1 (abstract P69)

Conclusion

Criteria used for intubation in SPP must be more rigorous. According to our study, patients with GCS < 12 should be considered for intubation.