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While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use. Consequently, this study's objectives were to: (1) develop a new risk model with improved sensitivity compared to the CHIIDA model and (2) externally validate the new model and CHIIDA model in a multicenter data set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed children \u226418\u00a0years old with mTBI and intracranial injuries included in the PECARN head injury data set (2004\u20132006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for &gt; 24\u00a0h due to TBI, or death due to TBI. The new model was externally validated in a separate data set that included children treated at any one of six centers from 2006 to 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Based on 839 patients from the PECARN data set, a new risk model, the KIIDS\u2010TBI model, was developed that incorporated imaging (e.g., midline shift) and clinical (e.g., Glasgow Coma Scale score) findings. Based on the model\u2010predicted probability of the composite outcome, three cutoffs were evaluated to classify patients as \u201chigh risk\u201d for level of care decisions. In the external validation data set consisting of 1,630 patients, the most conservative cutoff (i.e., any predictor present) identified 119 of 119 children with the composite outcome (sensitivity\u00a0= 100%), but had the lowest specificity (26.3%). The other two decision\u2010making cutoffs had worse sensitivity (94.1%\u201396.6%) but improved specificity (67.4%\u201381.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The KIIDS\u2010TBI model has high sensitivity and moderate specificity for risk stratifying children with mTBI and intracranial injuries. Use of this CDS tool may help improve the safe, resource\u2010efficient management of this important patient population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14333","type":"journal-article","created":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T19:17:55Z","timestamp":1625944675000},"page":"1409-1420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Development and external validation of the KIIDS\u2010TBI tool for managing children with mild traumatic brain injury and intracranial injuries"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2675-5658","authenticated-orcid":false,"given":"Jacob K.","family":"Greenberg","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery Washington University School of Medicine in St. Louis St. Louis MO 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