Predictive Power of Cranial CT Scan Parameters in Outcomes of Patients with Traumatic Brain Injury based on NIRIS Scoring System in Iran


1 Kashan University of Medical Science

2 Kashan University of Medical Sciences

3 Trauma Research Center Kashan University of Medical Sciences


5 Sina Trauma and Surgery Research Center Tehran University of Medical Sciences



Traumatic Brain Injury (TBI) is one of the leading causes of death and long-term disability for people aged 35 and under. One of the diagnostic methods for its evaluation is computed tomography (CT) imaging of the brain and magnetic resonance imaging (MRI). Recently, the Neuroimaging Radiographic Interpreting System (NIRIS) is used to predict outcomes and manage these patients. The aim of this study was to investigate the predictive power of cranial CT scan parameters in the outcomes of patients with traumatic brain injury based on the NIRIS scoring system in Iran.
Material and Methods:
This retrospective cohort study was performed on 250 patients with the main diagnosis of TBI in 1398 in Shahid Beheshti University Hospital in Kashan. The patient’s demographic information along with the mechanism of injury and other variables were recorded in a special form. Checklists related to the three criteria of Marshall, Rotterdam and NIRIS were scored on CT scans of each patient. NIRIS scores also examined cranial bone fractures, brain tissue contogenization, intracranial hemorrhage, cerebral herniation, and midline shifts. All analyzes were performed using STATA software version 14
The results of this research showed that there was a statistically significant difference between factors such as age, Glasgow Consciousness Scale (GCS), Marshall, Rotterdam, and NIRIS scoring criteria, as well as the final outcome in patients with TBI between the two life and death groups (P<0.001). By ROC analysis, the power of diagnosis or correctness of the results in the scoring criteria showed that the Marshall criterion for predicting the mortality of patients with traumatic brain injury (AUC=0.78) was acceptable with a sensitivity of 83.33% and a specificity of 70.56%. Regarding the Rotterdam criteria, the detection power (AUC=0.86) and sensitivity of 66.67% and specificity of 86.15%, as well as NIRIS scoring criteria (AUC=0.84) with sensitivity of 83.33% and specificity of 76.62%.
In general, by examining the predictive power of skull CT scan parameters based on scoring criteria to predict mortality, it was found that the Rotterdam scoring criteria predicted mortality better than the other two criteria with a specific sensitivity of 86%.
Keywords: CT Scan; Skull; Traumatic brain injury; NIRIS.