Precision in pediatrics: validating the infant scalp score for TBI detection
Ali Riazi1, Ghazal Shahrokh2, Mehdi Nasr Isfahani3,4
1Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
The Infant Scalp Score (ISS) effectively predicts Traumatic Brain Injury (TBI) in young children. An ISS of 7 or higher accurately identifies clinically significant TBI, aiding in CT scan decisions.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Diagnostic Accuracy
Background:
- Traumatic Brain Injury (TBI) is a frequent cause of pediatric emergency visits, but intracranial injury is rare.
- Clinical judgment and institutional protocols guide CT scan decisions in children with head trauma.
- The Infant Scalp Score (ISS) was developed to assess TBI risk in infants.
Purpose of the Study:
- To evaluate the Infant Scalp Score (ISS) as a predictor of clinically significant TBI (ciTBI) in children under two.
- To assess the role of ISS in guiding CT scan decisions for pediatric head trauma.
- To determine optimal ISS cut-offs for predicting ciTBI.
Main Methods:
- Prospective, observational study of 161 pediatric head trauma cases.
- ISS calculated based on age, hematoma size (small, medium, large), and location.
- Statistical modeling, including ROC curve analysis, used to assess ISS predictive performance and associations with CT findings.
Main Results:
- Of 124 children who underwent CT, 25 (20.2%) had TBI, with 7 (4.34%) meeting ciTBI criteria.
- Hematomas ≥3 cm were significantly associated with higher TBI risk (OR=3.67, p=0.02).
- ISS ≥7 demonstrated strong predictive power for ciTBI (AUC=0.89, 95% CI: 0.72-0.94, p=0.04).
Conclusions:
- The Infant Scalp Score (ISS) demonstrates strong diagnostic accuracy in predicting TBI in children under two.
- An ISS of 7 or higher is a reliable cut-off for identifying children at risk of ciTBI.
- ISS is a valuable tool for guiding CT scan decisions, potentially reducing unnecessary radiation exposure in pediatric head trauma management.
Abstract:
Traumatic Brain Injury (TBI) is a common reason for pediatric emergency visits, though few cases lead to intracranial injury. This study evaluates the Infant Scalp Score (ISS) as a predictor of clinically significant TBI (ciTBI) and its role in guiding CT scan decisions for children under two at Al-Zahra and Kashani hospitals. This prospective, observational study analyzed patient outcomes using statistical modeling, including ROC curve analysis to determine optimal ISS cut-offs. Among 161 pediatric head trauma cases, 124 underwent CT imaging, identifying TBI in 25 cases (20.2%). CT decisions were guided by clinical judgment, institutional protocols, and physician discretion, with 30-day follow-up via phone consultation. ISS was calculated based on age, hematoma size, and location, classifying hematomas as small (< 1 cm), medium (1-3 cm), or large (> 3 cm). Data analysis in SPSS 25 utilized descriptive statistics and correlation tests to examine ISS-CT associations. A total of 161 pediatric patients (57% male, mean age 20.4 ± 9.8 months) with blunt head trauma were included. Among 124 children (77%) who underwent CT, 25 (20.2%) showed TBI, with 7 cases (4.34%) meeting ciTBI criteria. Hematomas ≥ 3 cm were significantly associated with higher TBI risk (OR = 3.67, p = 0.02). ISS ≥ 6 exhibited moderate predictive performance (AUC: 0.76, 95% CI: 0.62-0.85), increasing CT scan likelihood (OR = 1.73) and TBI detection (OR = 2.83). ISS ≥ 7 showed improved predictive power (AUC: 0.89, 95% CI: 0.72-0.94), reinforcing its role as the minimum predictive cut-off for ciTBI (p = 0.04). Overall, ISS demonstrated strong diagnostic accuracy (AUC = 0.876, 95% CI: 0.326-0.901), supporting its utility in guiding CT decisions and enhancing pediatric head trauma management. The Infant Scalp Score (ISS) effectively predicts TBI in children under two years old. ISS ≥ 6 identifies high-risk patients, while ISS ≥ 7 provides greater predictive accuracy, reinforcing its role in risk stratification. Larger hematomas (> 3 cm) further elevate TBI risk, emphasizing the importance of ISS in guiding CT scan decisions and reducing unnecessary radiation exposure.
