title: Performance of a decision rule to predict need for computed tomography among children with blunt head trauma.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, College of Medicine, University of California, Irvine, California, USA. jkrawczy@uci.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Oman
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Cooper
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Peter
authors.initials: P
authors.lastname: Viccellio
authors.forename: Andrew
authors.initials: A
authors.lastname: Nyce
authors.forename: Steven E
authors.initials: SE
authors.lastname: Ross
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed