Do all comatose patients need intubation?

In non-trauma patients, do you base your decision to intubate patients with decreased conscious level on the GCS? These guys in Scotland describe a series of poisoned patients with GCS range 3-14 managed on an ED observation unit without tracheal intubation, with no demonstrated cases of aspiration. They say: ‘This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED‘. Small numbers, but gets you thinking. This subject would make a great randomised controlled trial.

Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department
J Emerg Med. 2009 Nov;37(4):451-5