External validation of the Liverpool Head Injury Tomography Score for mild traumatic brain injury.
8 affiliations
- 1Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK. [email protected].
- 2Department of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK. [email protected].
- 3Department of Clinical Neurosciences, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK.
- 4Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
- 5Orion MedTech Ltd. CIC, Cambridge, UK.
- 6Perioperative, Acute, Critical, and Emergency Care (PACE) Section, Department of Medicine, University of Cambridge, Cambridge, UK.
- 7NIHR HealthTech Research Centre in Brain Injury, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- 8Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK.
Abstract
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.
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BibTeX
@article{gillespie2026external,
title = {{External validation of the Liverpool Head Injury Tomography Score for mild traumatic brain injury.}},
author = {Conor S Gillespie and Yuhan Guo and Matthew Kingham and Shangqing W Yang and Zhikai Li and Munashe Veremu and William H Cook and Youssef Chedid and Emily Simmons and Naomi Deakin and David Clark and Virginia F J Newcombe and Peter J Hutchinson and Catherine J McMahon and Alexis J Joannides and East of England Emergency Neurosurgery Collaborative},
journal = {Acta neurochirurgica},
year = {2026},
month = aug,
doi = {10.1007/s00701-026-06991-4},
url = {https://europepmc.org/article/MED/42967959},
note = {CC BY},
}
RIS
TY - JOUR
TI - External validation of the Liverpool Head Injury Tomography Score for mild traumatic brain injury.
AU - Conor S Gillespie
AU - Yuhan Guo
AU - Matthew Kingham
AU - Shangqing W Yang
AU - Zhikai Li
AU - Munashe Veremu
AU - William H Cook
AU - Youssef Chedid
AU - Emily Simmons
AU - Naomi Deakin
AU - David Clark
AU - Virginia F J Newcombe
AU - Peter J Hutchinson
AU - Catherine J McMahon
AU - Alexis J Joannides
AU - East of England Emergency Neurosurgery Collaborative
PY - 2026
DA - 2026/08/04
JO - Acta neurochirurgica
DO - 10.1007/s00701-026-06991-4
UR - https://europepmc.org/article/MED/42967959
AB - 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.
SN - 0001-6268
SN - 0942-0940
ER -