Clinical decision rule for reducing number of head CT's ordered for adults with blunt head trauma.
Head CT is not necessary if NONE of the following:
- Age ≥ 65 years old
- Scalp hematoma
- Neurologic deficit
- Cranial nerve deficit
- Motor deficit
- Cerebellar dysfunction: finger-nose-finger, heel-to-shin, and rapid alternating movement testing
- Gait abnormality: tandem steps, heel-to-toe walking, Romberg testing
- Inability to read and write name
- Altered level of alertness
- GCS < 15
- Delayed/inappropriate response
- Perseverating speech
- Somnolence
- Disorientation
- Inability to remember 3 objects at 5 minutes
- Abnormal behavior (any inappropriate action by the patient)
- Loss of consciousness
- Coagulopathy
- Drug-induced
- Hepatic dysfunction
- Hereditary (ie hemophilia)
- Recurrent / forceful vomiting
Derivation trial:
- Multicenter trial involving 21 centers, prospective, observational trial.
- All patients who underwent CT head imaging after blunt head trauma were automatically enrolled.
- 99.8% sensitive for identifying injuries requiring neurosurgical intervention (1 of 917 patients required ICP monitoring)
- 98% sensitive for clinically important findings
Validation trial:
- Prospective, multicenter, observational cohort study in Korea
- 7,131 patients enrolled, 2,951 eligible for scoring of NEXUS-II
- 95% sensitive for requiring neurosurgical intervention (95% CI: 90-98%)
- 89% sensitive for clinically important brain injury (95% CI: 86-91%)
- Lower sensitivities may be secondary to differences in neurosurgical practice between populations
Mower, W et al. Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients. J Trauma. 2005; 59: 954–959. Text
Sun Ro, Y et al. Comparison of Clinical Performance of Cranial Computed Tomography Rules in Patients With Minor Head Injury: A Multicenter Prospective Study. Acad Emerg Med. 2011; 18: 597–604.