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Background <p>Mild Traumatic Brain Injury (mTBI) neurosurgical referrals are increasing. This study aimed to externally validate a radiological scoring system to define a ‘neurosurgically significant’ mild TBI and evaluate its impact on referral outcome if implemented.</p> Method <p>Retrospective, external validation of the UK Liverpool Head Injury Tomography Score (LIV-HITS). Consecutive neurosurgery referrals to a tertiary neurosurgery centre for mild TBI were included (1st January 2022—30th June 2022). Mechanism of injury, LIV-HITS and management decision were identified, and diagnostic accuracy determined.</p> Results <p>A total of 1547 referrals were included. 147 (9.5%) were accepted for transfer, and 1400 (90.5%) were designated as local management. For neurosurgical transfer, the sensitivity of LIV-HITS was 99.3% and the specificity was 43.9%, with a positive predictive value of 15.7%, and negative predictive value of 99.8%. Discriminatory power of the model was fair (AUC 0.71, 95% CI 0.66–0.76). In 6&#xa0;months, the score identified 615 referrals (39.8%) that could have been successfully triaged to local management if the scoring system was used.</p> Conclusions <p>The LIV-HITS has a sensitivity of over 99% for excluding a neurosurgically significant mild TBI in an externally validated cohort. However, the discriminatory power of the score is poor for stratifying which patients eventually get transferred to a neurosurgical centre. The score in clinical practice could be used as a ‘rule out’ tool for mild TBI referrals, whilst identifying potentially significant mild TBI that would warrant emergency neurosurgical consideration.</p>

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External validation of the Liverpool Head Injury Tomography Score for mild traumatic brain injury

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Conor S. Gillespie,
  • Yuhan Guo,
  • Matthew Kingham,
  • Shangqing W. Yang,
  • Zhikai Li,
  • Munashe Veremu,
  • William H. Cook,
  • Youssef Chedid,
  • Emily Simmons,
  • Naomi Deakin,
  • David Clark,
  • Virginia F. J. Newcombe,
  • Peter J. Hutchinson,
  • Catherine J. McMahon,
  • Alexis J. Joannides,
  • Prabhjot Singh Malhotra,
  • Benjamin M. Davies,
  • Sara Venturini,
  • Edoardo Viaroli,
  • Mutwakil Abdulla,
  • Adam M. H. Young,
  • Yevgeny Karepov,
  • Muhammad Shuaib Khan,
  • Oliver Mowforth,
  • Midhun Mohan,
  • Saeed Kayhanian,
  • Richard Bartlett,
  • Stefan Yordanov,
  • Agnieszka Zakrzewska,
  • Francisca Ferreira,
  • Kirsty Grieve

摘要

Background

Mild Traumatic Brain Injury (mTBI) neurosurgical referrals are increasing. This study aimed to externally validate a radiological scoring system to define a ‘neurosurgically significant’ mild TBI and evaluate its impact on referral outcome if implemented.

Method

Retrospective, external validation of the UK Liverpool Head Injury Tomography Score (LIV-HITS). Consecutive neurosurgery referrals to a tertiary neurosurgery centre for mild TBI were included (1st January 2022—30th June 2022). Mechanism of injury, LIV-HITS and management decision were identified, and diagnostic accuracy determined.

Results

A total of 1547 referrals were included. 147 (9.5%) were accepted for transfer, and 1400 (90.5%) were designated as local management. For neurosurgical transfer, the sensitivity of LIV-HITS was 99.3% and the specificity was 43.9%, with a positive predictive value of 15.7%, and negative predictive value of 99.8%. Discriminatory power of the model was fair (AUC 0.71, 95% CI 0.66–0.76). In 6 months, the score identified 615 referrals (39.8%) that could have been successfully triaged to local management if the scoring system was used.

Conclusions

The LIV-HITS has a sensitivity of over 99% for excluding a neurosurgically significant mild TBI in an externally validated cohort. However, the discriminatory power of the score is poor for stratifying which patients eventually get transferred to a neurosurgical centre. The score in clinical practice could be used as a ‘rule out’ tool for mild TBI referrals, whilst identifying potentially significant mild TBI that would warrant emergency neurosurgical consideration.