Precision in pediatrics: validating the infant scalp score for TBI detection

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.