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Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population
David Dornbos1,2, Christy Monson, 3
11Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Insights
The Surgical Intervention for Traumatic Injury (SITI) scale effectively identifies pediatric traumatic brain injury (TBI) patients needing surgery. This tool improves communication for surgical urgency in pediatric TBI cases.
Area of Science:
- Neurosurgery
- Pediatric Traumatology
- Medical Imaging
Background:
- The Glasgow Coma Scale (GCS) assesses traumatic brain injury (TBI) severity but doesn't predict surgical intervention needs.
- A novel scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, was developed for adults with TBI to indicate potential surgical decompression requirements.
Purpose of the Study:
- To adapt and validate the SITI scale for pediatric traumatic brain injury (TBI) patients.
- To assess the SITI scale's utility in communicating the potential need for surgical decompression in children with TBI.
Main Methods:
- Retrospective evaluation of a neurotrauma database from a level 1 pediatric trauma center (2010-2015).
- Calculation of SITI scores for pediatric TBI patients using clinical and radiographic data (GCS, pupillary exam, CT findings).
- Primary endpoint: emergent operative intervention (craniotomy/craniectomy for decompression within 24 hours).
Main Results:
- 1524 pediatric TBI patients were analyzed; 3.6% required emergent surgery.
- Mean SITI scores significantly differed between operative (4.98) and nonoperative (0.41) groups (p < 0.0001).
- The SITI scale demonstrated high diagnostic accuracy (AUROC = 0.98) for predicting surgical intervention in pediatric TBI.
Conclusions:
- The SITI scale is a valuable tool for assessing the need for surgical decompression in pediatric TBI.
- Its application in a pediatric population confirms its correlation with emergent surgical intervention.
- The SITI scale enhances communication regarding surgical urgency in pediatric TBI cases.
Objective:
While the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.
Methods:
The SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.
Results:
A total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.
Conclusions:
The SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.
