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Author Notes:

Address for Correspondence: Eric Sribnick, MD, Nationwide Children’s Hospital, Division of Neurosurgery, 700 Children’s Drive, Columbus, OH 43205-2664. Email: eric.sribnick@nationwidechildrens.org

There are no conflicts of interest or sources of funding to declare.



  • surgical intervention
  • traumatic brain injury
  • surgical decompression
  • Surgical Intervention for Traumatic Injury (SITI)
  • radiography
  • Glasgow Coma Scale
  • pupil examination
  • computed tomography (CT)
  • craniotomy
  • craniectomy

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


Journal Title:

Western Journal of Emergency Medicine


Volume 20, Number 4


, Pages 578-584

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2019 Sribnick et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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