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. 2019 Jul;20(4):578-584.
doi: 10.5811/westjem.2019.4.41802. Epub 2019 Jun 18.

The Surgical Intervention for Traumatic Injury Scale: A Clinical Tool for Traumatic Brain Injury

Eric A Sribnick  1   2 , Michael Lunney  3 , David W Wright  3 , Jason W Allen  4 , Patricia A Hudgins  4 , Junxin Shi  5 , Krista Wheeler  5 , Jeffrey R Leonard  1   2 , Sanjay S Dhall  6 , Henry Xiangh  5
Affiliations

The Surgical Intervention for Traumatic Injury Scale: A Clinical Tool for Traumatic Brain Injury

Eric A Sribnick et al. West J Emerg Med. 2019 Jul.

Abstract

Introduction: There is no widely used method for communicating the possible need for surgical intervention in patients with traumatic brain injury (TBI). This study describes a scoring system designed to communicate the potential need for surgical decompression in TBI patients. The scoring system, named the Surgical Intervention for Traumatic Injury (SITI), was designed to be objective and easy to use.

Methods: The SITI scale uses radiographic and clinical findings, including the Glasgow Coma Scale Score, pupil examination, and findings noted on computed tomography. To examine the scale, we used the patient database for the Progesterone for the Treatment of Traumatic Brain Injury III (ProTECT III) trial, and retrospectively applied the SITI scale to these patients.

Results: Of the 871 patients reviewed, 164 (18.8%) underwent craniotomy or craniectomy, and 707 (81.2%) were treated nonoperatively. The mean SITI score was 5.1 for patients who underwent surgery and 2.5 for patients treated nonoperatively (P<0.001). The area under the receiver operating characteristic curve was 0.887.

Conclusion: The SITI scale was designed to be a simple, objective, clinical decision tool regarding the potential need for surgical decompression after TBI. Application of the SITI scale to the ProTECT III database demonstrated that a score of 3 or more was well associated with a perceived need for surgical decompression. These results further demonstrate the potential utility of the SITI scale in clinical practice.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Flowchart of retrospective patient selection from the ProTECT III database. ProTECT III, Progesterone for the Treatment of Traumatic Brain Injury III Trial; SITI, Surgical Intervention for Traumatic Injury.
Figure 2
Figure 2
The Surgical Intervention for Traumatic Injury (SITI) score at admission for operative and nonoperative patients.
Figure 3
Figure 3
The area under the receiver operating characteristic (ROC) curve using a Surgical Intervention for Traumatic Injury (SITI) score of 3 as the threshold. Area under the curve = 0.8866.
See this image and copyright information in PMC

References

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