Evaluation of the SITE score for de-novo spinal infection patients in clinical practice - A case-based approach.

Study design: Validation study. Introduction: De-novo spinal infections (DNSI) are a concerning healthcare problem. The treatment is established case-based in the absence of clear guidelines. The recently proposed Spinal-Infection-Treatment-Evaluation (SITE) score combines clinical and radiological variables to support decision-making, but it has not been validated among non-spine surgeons. Research question: We aimed to validate this novel score in a real-life setting among surgeons from different clinical specialties. Methods: A single-center study was conducted from 1/10/2023 until 31/12/2023. We collected clinical and radiological data of DNSI patients, treated at our institution. We created fifteen representative specific case presentations, including all spinal locations. A survey was designed to distribute the specific case presentations among physicians from the departments that agreed to participate. Participants were asked to score each case by using the SITE score and calculated intra-class correlation coefficients (ICC3). Results: Forty-eight survey forms were analyzed (seven spine-surgeons, 41 others) Spine surgeons demonstrated good interobserver reliability (ICC3 = 0.78). Non-spine surgeons showed poor interobserver reliability (ICC3 = 0.48). Subgroup analysis by specialty revealed overall low reliability scores (internal medicine ICC3 = 0.48, orthopaedics ICC3 = 0.43, other surgical specialties ICC3 = 0.56, infectiology ICC3 = 0.55). Participants with more frequent exposure to DNSI (>10 per year; n = 9) showed higher reliability, achieving similar scores to spine surgeons (ICC3 = 0.7). Discussion and conclusions: We found acceptably high interobserver values for the SITE score only for spine surgeons and non-spine surgeons with frequent exposure to DNSI. The reliability of the score was much lower when applied by physicians from other specialties with lesser experience of DNSI.