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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Pediatric NEXUS II Head CT Decision Instrument for Blunt Trauma

    Predicts need for head CT after pediatric blunt head injury, similar to PECARN.

    INSTRUCTIONS

    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. 

    Note: We recommend using PECARN over other pediatric head trauma rules, as it is the most widely validated (see Next Steps for details).

    When to Use
    Pearls/Pitfalls
    Why Use

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

    • Only patients for whom the clinician was going to perform a head CT (regardless of the decision tool result) were included in the study.

    • May not have adequate sensitivity in patients with high GCS scores (14-15), as GCS scores were not reported.

    • Outcomes of those who did not have head CT performed based on clinical gestalt are not known.

    • The validation study included only 35% male patients, which is in stark contrast to previous studies that have found boys were more likely to present with head injuries (64.8%, 65%, and 62% of patients were male in CATCH, CHALICE, and PECARN respectively).

    • The study population was substantially older compared to those for previous decision instruments (11.9 years, versus 7.1 years in PECARN).

    • Because this study did not enroll patients who did not undergo head CT, no firm conclusions can be made regarding whether this decision instrument would have satisfactory sensitivity and/or reduce head CT imaging in ALL pediatric patients with head trauma.

    May safely reduce use of head CT imaging (derivation and validation showed 100% sensitivity for identifying patients requiring neurosurgical intervention, with subsequent reduction in head CT of 25% and 34%, respectively).

    Criteria

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. William R. Mower

    About the Creator

    William R. Mower, MD, PhD, is a physician at the UCLA Emergency Medical Center. He is also a professor of medicine at the University of California Geffen School of Medicine. Dr. Mower’s primary research is focused on computed tomography and diagnostic radiology.

    To view Dr. William R. Mower's publications, visit PubMed

    Are you Dr. William R. Mower? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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