A clinical scale to communicate surgical urgency for traumatic brain injury: A preliminary study

• Type of Material: Article
• Authors: John Hanfelt, Emory University; Eric A. Sribnick, Emory University; Sanjay S. Dhall, University of California at San Francisco
• Language: English
• Date: 2015-01-05
• Publisher: Medknow Publications
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Sribnick EA
• Final Published Version (URL): http://surgicalneurologyint.com/surgicalint_articles/a-clinical-scale-to-communicate-surgical-urgency-for-traumatic-brain-injury-a-preliminary-study/
• Title of Journal or Parent Work: Surgical Neurology International
• ISSN: 2229-5097
• Volume: 6
• Issue: 1
• Grant/Funding Information: Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.
• Keywords: traumatic brain injury; emergency medicine; Glasgow Coma Scale; Computed tomography; neurosurgery
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

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 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. - See more at: http://surgicalneurologyint.com/surgicalint_articles/a-clinical-scale-to-communicate-surgical-urgency-for-traumatic-brain-injury-a-preliminary-study/#sthash.LfHhCfGE.dpuf