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Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma

Selective head CT after paediatric blunt head injury.

Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma
Evidence of significant skull fracture
Scalp haematoma
Neurological deficit
Abnormal level of alertness
Abnormal behaviour
Persistent vomiting
Coagulopathy
ResultLow risk

No risk criteria present. A clinically important intracranial injury is very unlikely and CT may reasonably be deferred.

Risk criteria present
0 of 7

When to use

  • Deciding whether a child being considered for head CT after blunt head trauma can avoid imaging.

Formula

Seven criteria: significant skull fracture, scalp haematoma, neurological deficit, abnormal alertness, abnormal behaviour, persistent vomiting, coagulopathy. Any criterion present = not low risk.

Pearls and pitfalls

  • Derived and validated only in children already being considered for head CT; do not apply to trivial injuries.
  • For general paediatric head injury the PECARN rule is more widely used and better validated in unselected children.

References

  1. Gupta MN, et al. Validation of the pediatric NEXUS II head CT decision instrument. Acad Emerg Med. 2018;25(6):618-25.
  2. Mower WR, et al. Developing a decision instrument to guide CT imaging of blunt head injury patients (NEXUS II). J Trauma. 2005;59(4):954-9.