Performance of a decision rule to predict need for computed tomography among children with blunt head trauma
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. An analysis was conducted of the pediatric cohort involved in the derivation set of National Emergency X-Radiogra...
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Published in | Pediatrics (Evanston) Vol. 117; no. 2; p. e238 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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United States
01.02.2006
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Abstract | 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.
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.
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.
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. |
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AbstractList | 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.
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.
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.
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. |
Author | Oman, Jennifer A Viccellio, Peter Hoffman, Jerome R Cooper, Richelle J Mower, William R Nyce, Andrew Ross, Steven E Holmes, James F |
Author_xml | – sequence: 1 givenname: Jennifer A surname: Oman fullname: Oman, Jennifer A email: jkrawczy@uci.edu organization: Department of Emergency Medicine, College of Medicine, University of California, Irvine, California, USA. jkrawczy@uci.edu – sequence: 2 givenname: Richelle J surname: Cooper fullname: Cooper, Richelle J – sequence: 3 givenname: James F surname: Holmes fullname: Holmes, James F – sequence: 4 givenname: Peter surname: Viccellio fullname: Viccellio, Peter – sequence: 5 givenname: Andrew surname: Nyce fullname: Nyce, Andrew – sequence: 6 givenname: Steven E surname: Ross fullname: Ross, Steven E – sequence: 7 givenname: Jerome R surname: Hoffman fullname: Hoffman, Jerome R – sequence: 8 givenname: William R surname: Mower fullname: Mower, William R |
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SubjectTerms | Adolescent Brain Injuries - diagnostic imaging Child Child, Preschool Cohort Studies Decision Support Techniques Emergency Service, Hospital Female Head Injuries, Closed - diagnostic imaging Humans Infant Male Sensitivity and Specificity Tomography, X-Ray Computed |
Title | Performance of a decision rule to predict need for computed tomography among children with blunt head trauma |
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