Published online January 17, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e238-e246 (doi:10.1542/peds.2005-1063)
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Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

Jennifer A. Oman, MDa, Richelle J. Cooper, MD, MSHSb, James F. Holmes, MDc, Peter Viccellio, MDd, Andrew Nyce, MDe, Steven E. Ross, MDf, Jerome R. Hoffman, MDb, William R. Mower, MD, PhDb for the NEXUS II Investigators

a Department of Emergency Medicine, College of Medicine, University of California, Irvine, California
b Division of Emergency Medicine, School of Medicine, University of California, Los Angeles, California
c Division of Emergency Medicine, School of Medicine, University of California, Sacramento, California
d Division of Emergency Medicine, State University of New York, Stonybrook, New York
e Departments of Emergency Medicine
f Surgery, Cooper University Hospital, Camden, New Jersey

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.

Key Words: blunt injuries • head trauma • pediatric

Abbreviations: ED—emergency department • ICI—intracranial injury • CT—computed tomography • NEXUS II—National Emergency X-Radiography Utilization Study II • CI—confidence interval • NPV—negative predictive value

Accepted Jul 25, 2005.




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