Performance of the necker cranial injury scale as a predictor of prognosis in children with severe traumatic brain injury: A retrospective cohort study

Background and objective: The management of children with severe traumatic brain injury (TBI) is a challenge for the health team, and the use of scales and algorithms in clinical practice help in making certain decisions. The aim of this study is to evaluate the performance of the Necker Cranial Injury Scale (NCIS) in pediatric patients with severe TBI. Methods: Retrospective cohort study with review of medical records of pediatric patients <17 years with severe TBI treated between January 2016 and December 2023 at a Brazilian reference trauma center. The analysis of the area under the curve (AUC) of the Receiver operating characteristic (ROC) was performed to check the performance of the NCIS and the Glasgow coma scale (GCS) as mortality predictive scales. Results: We identified 45 pediatric patients with severe TBI, with a median age of 9 years (IQR 5-14), and a predominance of males (71%). There was a predominance of accidents on public roads (22 of 45, 49%) followed by home accidents (21 of 45, 47%). With a median score of 6 (IQR 5-8) on the GCS, the performance of the NCIS (AUC 0.92) was superior to the performance of the GCS (AUC 0.86). The NCIS 3 cutoff point showed a specificity of 89%, negative predictive value of 97%, and accuracy of 89%. Conclusions: With excellent performance and high negative predictive value, the NCIS is efficient for use in clinical practice in children with severe TBI.