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.
Highlights
Traumatic brain injury (TBI) remains a major health concern in the United States with an estimated 1.36 million emergency room visits, 275,000 hospital admissions, and 52,000 deaths.[3]
Quick Response Code: Surgical Neurology International 2015, 6:1. This year, 2014, marks the 40th anniversary of the Glasgow coma scale (GCS),[7] which aided in the assessment of comatose patients with traumatic brain injuries (TBI)
This could be of considerable importance, for instance, when transferring a traumatic brain injury (TBI) patient from a smaller receiving institution to a specialized tertiary care facility or trauma level 1 center and it is especially valuable to have such a scale available for the nonneurosurgical provider
Summary
Traumatic brain injury (TBI) remains a major health concern in the United States with an estimated 1.36 million emergency room visits, 275,000 hospital admissions, and 52,000 deaths.[3]. While the Glasgow Coma Scale (GCS) provides a reproducible and convenient way of quickly assessing the level of consciousness in TBI patients,[8] the GCS score alone does not provide enough information to guide surgical decision making.[2] The decision to perform craniotomy for the treatment of TBI is multi‐factorial, incorporating both clinical and radiographic findings.[2] a scoring system designed to describe a patient’s need for surgery should incorporate this information. 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
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