F. Miranda and V. Blunda agree that this surname has a dialectal origin and is linked with the word that designates the hospital. Miranda notes that the surname, together with its variant Spitali, could derive from ospedale ("hospital"), and that its dialectal forms arose because the first bearers worked in hospital establishments —as watchmen or nurses— or else because they were foundlings entrusted to confraternities of that kind. Blunda, for his part, specifies that the dialectal form spitàli preserves the Sicilian outcome of the Latin hospitalis, a term that designated the institutional refuge for the sick and pilgrims, and adds that as a surname it could also have originated in a microtoponym applied to a person living next to such an establishment.

Miranda further provides a relevant historical context: from the 11th century, under the aegis of the orders of the Knights and the Hospitallers, some spitali were established in Sicily where the sick, beggars and foundlings were received, which would explain the rooting of the term on the island and its later transformation into a surname.

As for its geographical distribution, Miranda indicates that the surname is present mainly in Sicily, where it is documented in the Palermo, Catania, Enna, Syracuse, Agrigento, Ragusa and Caltanissetta areas, and that it also appears in other regions of Italy such as Piedmont, Tuscany, Lombardy, Liguria, Umbria, Veneto, Lazio, Trentino-Alto Adige and Emilia-Romagna. Blunda, on the other hand, characterises it as a specifically Sicilian surname, without mentioning its presence outside the island.