Objective To investigate the value of Nurse Intuition Patient Deterioration Scale (NIPDS) and the National Early Warning Score (NEWS) in predicting the risk of deterioration in critically ill neurosurgical patients. Methods Using a convenience sampling method, we selected 300 neurosurgical inpatients between October 2024 and April 2025. Both the NIPDS and NEWS were used to assess patient status. Taking composite outcomes—defined as emergency calls, activation of the rapid response system, unplanned transfer to sub-critical units/ICU, and death—as the gold standard, we evaluated the agreement and diagnostic performance of the two assessment tools. Results A total of 300 patients were included in this study, of which 55 (18.33%) had a positive comprehensive outcome. The Kappa value of NEWS and NIPDS was 0.489 (P<0.05). The area under the ROC curve of NIPDS was 0.816 (95%CI 0.759-0.872), the sensitivity was 0.473, and the specificity was 0.878, and the area under the ROC curve of NEWS was 0.716 (95%CI 0.640-0.792), with a sensitivity of 0.400 and a specificity of 0.849. Conclusion NIPDS and NEWS have high predictive performance in predicting the risk of deterioration in critically ill neurosurgical patients, among which NIPDS has slightly higher sensitivity and specificity than NEWS.