External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children

Area of Science:

• Pediatric Neurosurgery
• Trauma Surgery
• Clinical Decision Support

Background:

• Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children.
• Predicting the need for acute neurosurgical intervention is critical for timely management.
• The Surgical Intervention for Traumatic Injuries (SITI) scale was developed to assess the likelihood of surgical decompression in TBI patients.

Purpose of the Study:

• To evaluate the performance of the SITI score in predicting the need for acute neurosurgical intervention in pediatric TBI patients.
• To determine the accuracy of the SITI scale in identifying children requiring decompressive surgery.

Main Methods:

• A retrospective, observational study of pediatric TBI patients at a level 1 trauma center.
• Data collection included International Classification of Diseases codes and SITI scores, with outcomes assessed for decompressive craniotomy/craniectomy within 24 hours.
• Performance metrics included receiver operating characteristic (ROC) curves, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Main Results:

• Of 656 TBI encounters, 5.9% required surgical decompression.
• Mean SITI scores differed significantly between operative (4.15) and nonoperative (0.40) groups (P < 0.001).
• A SITI score cutoff of ≥2 demonstrated high performance (AUC 0.89), with sensitivity 0.79, specificity 0.90, PPV 0.34, and NPV 0.99. Sensitivity analysis for depressed skull fractures showed improved performance (AUC 0.98).

Conclusions:

• A SITI score <2 is associated with nonoperative management in pediatric TBI.
• The SITI scale is a valuable tool for predicting neurosurgical intervention in children with TBI.
• Clinicians must exercise caution with low SITI scores in patients with depressed skull fractures due to potential for missed surgical indications.