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Observational Study
. 2025 Jul 17;15(1):26014.
doi: 10.1038/s41598-025-11767-4.

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

Ali Riazi  1 , Ghazal Shahrokh  2 , Mehdi Nasr Isfahani  3   4
Affiliations
Observational Study

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

Ali Riazi et al. Sci Rep. .

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.

Keywords: CT scan; Child; Head injury; Infant scalp score; TBI; Trauma.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki in its current version (World Medical Association [WMA], 2013). The ethics committee of Isfahan University of Medical Sciences approved this study (approval number: IR.MUI.MED.REC.1402.474). Through the informed oral consent of patients or their first-degree relatives, data were collected and presented anonymously in this project. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve for ISS in predicting TBI.
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