Trauma patients with a depressed level of consciousness as a result of head injury and/or alcohol have an unreliable physical examination which may lead to errors or delays in diagnosis. The purpose of this study was aimed to develop guidelines for routine radiologic skeletal surveys and physical examination in patient with depressed level of consciousness in order to reduce the missing rate of the occult injuries. The authors analyzed 278 patients of the musculoskeletal injury with depressed level of consciousness experienced in the Department of Orthopaedic Surgery, Chung-Ang university from July 1984 to September 1991. In the initial level of consciousness by Glasgow coma scale, mild impairment was 176 patients (63%), moderate impairment was 35 patients (13%) and severe impairment was 67 patients (24%). Major skeletal injury (MSI) was defined as one or more fractures or dislocations of the axial spine, pelvis, hip or long bones of the lower evtremity. The incidence of MSI in these patients population was 122 patients (43.9%). Among these patients, pelvis fractures occurred most frequently, the next were axial spine injuries, tibia and fibula fractures, and femur fractures, in order. Multiple skeletal injuries were common; the average numbers of site of all skeletal injuries were 1.8, and 45 patients (37%) with MSI had two or more major skeletal injuries. The overall incidence of delayed diagnosis in these patients population was 34 patients (12.2%). Among these patients, delayed diagnosis of the knee ligament injuries occurred most frequently, the others were cervical spine fracture, thoracic spine fracture, clavicle fracture, pelvis fracture, fibula fracture, metacarpal/finger fracture, shoulder dislocation, and scapula fracture.