Validation of the NeuroImaging Radiological Interpretation System for Acute Traumatic Brain Injury

J Comput Assist Tomogr. Sep/Oct 2019;43(5):690-696. doi: 10.1097/RCT.0000000000000913.


Purpose: The aim of the study was to refine and validate the NeuroImaging Radiological Interpretation System (NIRIS), which was developed to predict management and clinical outcome based on noncontrast head computerized tomography findings in patients suspected of acute traumatic brain injury (TBI).

Methods: We assessed the performance of the NIRIS score in a prospective, single-center cohort of patients suspected of TBI (n = 648) and compared the performance of NIRIS with that of the Marshall and Rotterdam scoring systems. We also revised components of the NIRIS scoring system using decision tree methodologies implemented on pooled data from the retrospective and prospective studies (N = 1190).

Results: The NIRIS performed similarly to the Marshall and Rotterdam scoring systems in predicting mortality and markedly better in terms of predicting more granular elements of disposition and management of TBI patients, such as admission, follow-up imaging, intensive care unit stay, and neurosurgical procedures. The revised NIRIS classification correctly predicted disposition and outcome in 91.2% (331/363) after excluding patients with other major extracranial traumatic injuries or intracranial nontraumatic injuries.

Conclusions: The present study further demonstrates the predictive value of NIRIS in guiding standardized clinical management and decision-making regarding treatment options for TBI patients.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Brain Injuries, Traumatic / mortality
  • Brain Injuries, Traumatic / therapy
  • Decision Making
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuroimaging / methods*
  • Predictive Value of Tests
  • Prospective Studies
  • Tomography, X-Ray Computed / methods*
  • Trauma Severity Indices