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Siti Scale: A Clinical Tool For Communicating Potential Need For Surgery Following Pediatric Traumatic Brain Injury
*Eric A Sribnick, Jeffrey R Leonard, David David Dornbos, III
Nationwide Children's Hospital, Columbus, OH

Background (issue):
The Glasgow Coma Scale (GCS) is effective in conveying severity in traumatic brain injury (TBI) but does not predict potential need for surgical intervention. This study describes a scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, designed to communicate potential need for surgical decompression in pediatric TBI patients.
Methods:
The SITI scale uses clinical and radiographic findings, including GCS, pupillary examination, and computed tomography findings. To validate the scale, a trauma database at a pediatric Level 1 trauma center was retrospectively evaluated. The SITI score for all patients with an admission diagnosis of moderate to severe TBI between 2010 and 2015 was calculated. Operative intervention was defined as a craniotomy or craniectomy performed within 24 hours of admission.Findings:
Of the 1578 patients reviewed, 56 underwent surgery. The mean SITI score was 4.90.02 for patients who underwent surgery and 0.40.29 for patients treated non-operatively (P<0.001). The area under the receiver operating characteristic curve was used to examine diagnostic accuracy of the SITI scale in this population, and the area under the curve for this analysis was 0.98.Conclusions (implications for practice):
The SITI scale was designed to be a simple, objective clinical tool to communicate potential need for surgical decompression after TBI. The SITI scale has been studied in adults, but we report its first application for pediatric TBI. Retrospective application of the SITI scale to a pediatric neurotrauma database demonstrated that a higher SITI score correlated with perceived need for surgery. These results suggest diagnostic accuracy and potential utility of the SITI scale in clinical pediatric practice.


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