Pediatric Oncall

Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma

Criteria
Evidence of skull fracture e.g. periorbital or periauricular ecchymoses, hemotympanum, drainage of clear fluid from ears or nose, palpable step-off, stellate laceration
Scalp hematoma Injuries not involving calvarium (e.g. hematomas limited to the face/neck) are not considered scalp hematomas
Neurologic deficit Any abnormal neurologic finding revealed by detailed exam
Abnormal level of alertness e.g. GCS ≤14; delayed or inappropriate response to external stimuli; excessive somnolence; disorientation to person, place, time, or events; inability to remember three objects at 5 mins; perseverating speech
Abnormal behavior Any inappropriate action, e.g. excessive agitation, inconsolability, refusal to cooperate, lack of affective response to questions or events, violent activity
Persistent vomiting Recurrent (≥1 episode) projectile or forceful emesis, either observed or by history, after trauma
Coagulopathy Any clotting impairment, e.g. hemophilia, secondary to medications (Coumadin, heparin, aspirin, etc), hepatic insufficiency

Result :

Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma : Low

CT not necessary (100% sensitive for findings requiring neurosurgical intervention)

References

Mower WR, Hoffman JR, Herbert M, et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59(4):954-9.
Oman JA, Cooper RJ, Holmes JF, et al. Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics. 2006;117(2):e238-46.

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All Information contained in and produced by the Pediatric Oncall system is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease. This information is not intended to replace clinical judgement or guide individual patient care in any manner.

References

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