Consider The Evidence: Med/Peds Journal Roundup

February 2, 2006

Choosing which kids with head injury get CT – NEXUSII

Filed under: pediatrics — medblog @ 4:17 am

Pediatrics 2/1 – Its often hard to decide which kids with head trauma can go home without a head scan. As part of the NEXUSII trial, Oman et al. investigate which criteria best predict intracranial injuries (ICI) in kids that bonk their heads. Using some fancy analysis they found the 7 best criteria from a set of 19 that identify those at highest risk for ICI. This decision rule had 98.6% sensitivity (missed only 2 of 1666 pts with ICI) and correctly worked in all cases of patients under 3 y/o who are often more difficult to assess .

Bottom Line: If the patient has any one of the following, they should get a head CT.
1.) evidence of significant skull fracture, 2.) altered level of alertness, 3.) neurologic deficit, 4.)persistent vomiting, 5.) presence of scalp hematoma, 6.) abnormal behavior, 7.)coagulopathy

If not, send them home.

Performance of a Decision Rule to Predict Need for Computed Tomography Among Children With Blunt Head Trauma

Jennifer A. Oman, Richelle J. Cooper, James F. Holmes, Peter Viccellio, Andrew Nyce, Steven E. Ross, Jerome R. Hoffman, William R. Mower for the NEXUS II Investigators
Pediatrics 2006; 117: e238-e246.

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