External Validation of the SITE Score for De Novo Spinal Infections: A Retrospective Cohort Study

Study Design Retrospective Cohort Study. Objective De novo spinal infections (DNSI) require prompt treatment decisions, especially on conservative or surgical management. The Spinal Infection Treatment Evaluation (SITE) score was developed in 2022 to standardize treatment recommendations, but external validation remains limited. Methods In a retrospective, single-center study, we analyzed consecutive patients with DNSI treated between January 2016 and December 2022. We calculated SITE scores based on admission parameters and compared score-based treatment recommendations with actual clinical decisions. The primary outcome was concordance between SITE recommendations and treatment decisions. Secondary outcomes included individual component performance and discriminatory ability, as assessed using receiver operating characteristic analysis. Results We identified 95 patients with DNSI (mean age 66.4, 66.3% male). SITE scores ranged from 4-13 points. Treatment concordance with SITE recommendations was noticed in 82.1% of cases. In multivariate analysis, neurological status (OR 0.48, P = 0.006) and host comorbidities (OR 0.34, P = 0.035) were significant predictors of surgical treatment. The complete SITE score demonstrated a moderate ability (AUC 0.70) to classify for conservative or surgical treatment. Conclusions The SITE score demonstrated moderate predictive accuracy with good treatment concordance (82.1%) and clinically useful discriminatory performance (AUC 0.70). Its neurological component showed particular clinical value. However, clinicians were frequently found to override score recommendations for reasons not captured in the current SITE scoring system. Level of Evidence IV/3.