Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

David Dornbos; Christy Monson; CNP; Andrew Look; Kristin Huntoon; Luke G F Smith; Jeffrey R Leonard; Sanjay S Dhall; Eric A Sribnick

doi:10.3171/2020.2.PEDS19474

Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

J Neurosurg Pediatr. 2020 Apr 10;26(1):92-97. doi: 10.3171/2020.2.PEDS19474.

Authors

David Dornbos^{1

2}, Christy Monson; CNP³; Andrew Look¹, Kristin Huntoon¹, Luke G F Smith¹, Jeffrey R Leonard^{1

3}, Sanjay S Dhall⁴, Eric A Sribnick^{1

3}

Affiliations

¹ 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
² 2Department of Neurological Surgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, Tennessee.
³ 3Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio; and.
⁴ 4Department of Neurological Surgery, University of California, San Francisco, California.

PMID: 32276255
DOI: 10.3171/2020.2.PEDS19474

Abstract

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.

Keywords: Glasgow Coma Scale; decompressive hemicraniectomy; neurotrauma; trauma; traumatic brain injury.