title: A clinical scale to communicate surgical urgency for traumatic brain injury: A preliminary study.
abstract: BACKGROUND
  While the Glasgow Coma Scale (GCS) provides a tool for evaluating traumatic brain injury (TBI) patients, there is no widely used scale that provides guidance for surgical management. This study introduces a scoring system that physicians potentially could use to determine and communicate the need for surgical decompression in TBI patients. The proposed system is designed to be both comprehensive and easy to use.
  
  
  METHODS
  The Surgical Intervention for Traumatic Injury (SITI) scale uses radiographic and clinical findings. Patients were graded based on their GCS: GCS >12 received 0 points, GCS 9-12 received 1 point, and GCS <9 received 2 points. An enlarged unilateral pupil added 2 points. Computed tomography findings were also graded: midline shift <5 mm received 0 points, 5-10 mm received 2 points, and >10 mm received 4 points. The presence of temporal pathology added 1 point, and epidural hematoma (EDH) ≥10 mm added 2 points. Retrospective analysis of 48 patients was then performed using the SITI scale.
  
  
  RESULTS
  Of the 48 patients reviewed, 24 patients underwent craniotomy and the other 24 were treated non-operatively. The mean SITI score was 5.7 (range 3-10) for operative patients and 2.5 (range 1-4) for non-operative patients.
  
  
  CONCLUSIONS
  The proposed SITI scale is designed to be a simple, objective system for assisting in communication between clinical services and for suggesting the need for surgical decompression for TBI. Based upon our initial review, a SITI score of 3 or less correlated with non-operative management and a score of 5 or greater correlated with operative management. Given the results of this study, we believe that further development and research of the SITI scale are warranted.
authors: Department of Neurosurgery, Emory University, 1365 Clifton Road NE, Building B Suite 2200.
authors: Eric A
authors: EA
authors: Sribnick
authors: Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, 1518 Clifton Road NE Atlanta, GA 30322.
authors: John J
authors: JJ
authors: Hanfelt
authors: Department of Neurosurgical Surgery, University of California at San Francisco, 505 Parnassus Ave., Room 779 M San Francisco, CA 94143-0112.
authors: Sanjay S
authors: SS
authors: Dhall
keywords: Computed tomography; Glasgow Coma Scale; emergency medicine; neurosurgery; traumatic brain injury
references: J Emerg Med. 1987 May-Jun;5(3):197-208
references: 3429813
references: Spine (Phila Pa 1976). 2007 Oct 1;32(21):2365-74
references: 17906580
references: Lancet. 1974 Jul 13;2(7872):81-4
references: 4136544
references: J Trauma Acute Care Surg. 2014 Feb;76(2):431-6
references: 24458049
references: Crit Care Med. 2010 Mar;38(3):831-7
references: 20068467
references: Lancet Neurol. 2005 Dec;4(12):789-90
references: 16297833
references: Prog Brain Res. 2007;161:393-400
references: 17618993
references: J Neurosci Nurs. 2007 Apr;39(2):68-75
references: 17477220
references: Brain Inj. 2015;29(1):11-6
references: 25111571
references: J Neurosurg. 2011 Dec;115(6):1191-6
references: 21819195
references: Lancet. 1990 Jul 14;336(8707):101-3
references: 1975285
references: J Neurotrauma. 2007;24 Suppl 1:S1-2
references: 17511535
references: Br J Anaesth. 2014 Aug;113(2):286-94
references: 25038159
references: Neuroscience. 2014 Dec 26;283:245-55
references: 24973658