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Performance of a decision rule to predict need for computed tomography among children with blunt head trauma
Jennifer A Oman1, Richelle J Cooper, James F Holmes
1Department of Emergency Medicine, College of Medicine, University of California, Irvine, California, USA. jkrawczy@uci.edu
Insights
The NEXUS II head trauma decision instrument accurately identifies clinically important intracranial injury (ICI) in children with blunt head trauma. This tool is effective in identifying pediatric patients who do not require further imaging or intervention.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Radiology
Background:
- Blunt head trauma is common in children.
- Identifying clinically important intracranial injury (ICI) is crucial for appropriate management.
- The National Emergency X-Radiography Utilization Study II (NEXUS II) developed a decision instrument for head trauma.
Purpose of the Study:
- To evaluate the NEXUS II head trauma decision instrument's accuracy in identifying clinically important intracranial injury (ICI) in pediatric patients.
- To assess the instrument's performance in children aged 0-18 years and in very young children (<3 years).
Main Methods:
- Analysis of the pediatric cohort from the prospective, observational, multicenter NEXUS II study.
- Evaluation of an 8-variable decision instrument derived from the entire NEXUS II cohort.
- Determination of test performance characteristics for identifying clinically important ICI requiring intervention or associated with significant neurologic impairment.
Main Results:
- The NEXUS II instrument correctly identified 136 of 138 cases (98.6%) of clinically important ICI in 1666 pediatric patients.
- It classified 230 children as low risk.
- In children younger than 3 years (n=309), the instrument identified all 25 cases of clinically important ICI.
Conclusions:
- The NEXUS II decision instrument demonstrates high sensitivity for identifying clinically important intracranial injury in children with blunt head trauma.
- Clinically important ICI were infrequent in children without at least one NEXUS II risk criterion.
- The instrument is a valuable tool for risk stratification in pediatric head trauma.
Objective:
To assess the ability of the NEXUS II head trauma decision instrument to identify patients with clinically important intracranial injury (ICI) from among children with blunt head trauma.
Methods:
An analysis was conducted of the pediatric cohort involved in the derivation set of National Emergency X-Radiography Utilization Study II (NEXUS II), a prospective, observational, multicenter study of all patients who had blunt head trauma and underwent cranial computed tomography (CT) imaging at 1 of 21 emergency departments. We determined the test performance characteristics of the 8-variable NEXUS II decision instrument, derived from the entire NEXUS II cohort, in the pediatric cohort (0-18 years of age), as well as in the very young children (<3 years). Clinically important ICI was defined as ICI that required neurosurgical intervention (craniotomy, intracranial pressure monitoring, or mechanical ventilation) or was likely to be associated with significant long-term neurologic impairment.
Results:
NEXUS II enrolled 1666 children, 138 (8.3%) of whom had clinically important ICI. The decision instrument correctly identified 136 of the 138 cases and classified 230 as low risk. A total of 309 children were younger than 3 years, among whom 25 had ICI. The decision instrument identified all 25 cases of clinically important ICI in this subgroup.
Conclusions:
The decision instrument derived in the large NEXUS II cohort performed with similarly high sensitivity among the subgroup of children who were included in this study. Clinically important ICI were rare in children who did not exhibit at least 1 of the NEXUS II risk criteria.
