MDCalc

NEXUS Head CT Instrument

Predicts need for head CT after blunt head injury.

Use in patients ≥18 years old who have sustained blunt head trauma within the past 24 hours and in whom head CT is being considered.

Age ≥65 years

Evidence of significant skull fracture

e.g. periorbital or periauricular ecchymoses, hemotympanum, drainage of clear fluid from ears or nose, palpable step-off, stellate laceration (see Evidence for more detail)

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 (see Evidence for more detail)

Altered level of alertness

e.g. Glasgow Coma Scale (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

Coagulopathy

Any clotting impairment, e.g. hemophilia, secondary to medications (Coumadin, heparin, aspirin, etc), hepatic insufficiency

Persistent vomiting

Recurrent (>1 episode) projectile or forceful emesis, either observed or by history, after trauma

Result:

Please fill out required fields.
Management
  • Negative result (score 0): Discuss with the patient the low likelihood of significant injury. Consider observation and provide instructions for warning signs that should lead to a return for evaluation, such as altered mental status or vomiting.
  • Positive result (score ≥1): Proceed with CT imaging to evaluate for clinically significant intracranial injury (e.g., hematoma/hemorrhage, skull fracture).
Have feedback about this calculator?