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.
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: Martin H Osmond; Terry P Klassen; George A Wells; Rhonda Correll; Anna Jarvis; Gary Joubert; Benoit Bailey; Laurel Chauvin-Kimoff; Martin Pusic; Don McConnell; Cheri Nijssen-Jordan; Norm Silver; Brett Taylor; Ian G Stiell Journal: CMAJ Date: 2010-02-08 Impact factor: 8.262
Authors: Adam L Dorfman; Reza Fazel; Andrew J Einstein; Kimberly E Applegate; Harlan M Krumholz; Yongfei Wang; Emmanuel Christodoulou; Jersey Chen; Ramon Sanchez; Brahmajee K Nallamothu Journal: Arch Pediatr Adolesc Med Date: 2011-01-03
Authors: Martin H Osmond; Terry P Klassen; George A Wells; Jennifer Davidson; Rhonda Correll; Kathy Boutis; Gary Joubert; Serge Gouin; Simi Khangura; Troy Turner; Francois Belanger; Norm Silver; Brett Taylor; Janet Curran; Ian G Stiell Journal: CMAJ Date: 2018-07-09 Impact factor: 8.262
Authors: Jennifer L Schachar; Richard L Zampolin; Todd S Miller; Joaquim M Farinhas; Katherine Freeman; Benjamin H Taragin Journal: Pediatr Radiol Date: 2011-04-05