A 24-year-old man sustains a severe head injury in a road traffic accident. On arrival, he opens eyes to pain, makes incomprehensible sounds, and localizes to painful stimuli. What is his Glasgow Coma Scale score, and does he meet the threshold for intubation?

• A GCS 9; no, intubation is not required
• B GCS 10; intubation is optional
• C GCS 8; intubation only if SpO2 falls below 90%
• D GCS 9; yes, GCS ≤8 indicates need for intubation ✓

Explanation

GCS scoring: eye opening to pain = 2, incomprehensible sounds = 2, localizes to pain = 5. Total = 9. However, the widely accepted threshold for endotracheal intubation in trauma is GCS ≤8 because patients below this level cannot protect their airway. The question tests both accurate scoring and the clinical cutoff. GCS 9 is above the ≤8 threshold, so intubation is not mandated solely on GCS, making option D correct in identifying the score and the standard threshold.

Reference: ATLS Advanced Trauma Life Support, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.