Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study

Paediat Res Emergency Dept Int

Research output: Contribution to journalArticle

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Abstract

Objective The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.

Methods We performed a prospective observational study of patients aged

Results Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had ICI as defined by NEXUS II. 74 (19.6% of ICI) patients underwent neurosurgery.

Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95% CI 97.3% to 99.7%)) and specificity was 9320/19 726 (47.2% (95% CI 46.5% to 47.9%)) for the total cohort. Sensitivity in the CT-only cohort was similar. Of the 18 022 children without CT in ED, 49.4% had at least one NEXUS II risk criterion. Sensitivity for ICI by the clinicians without the rule was 377/377 (100.0% (95% CI 99.0% to 100.0%)) and specificity was 18 147/19 732 (92.0% (95% CI 91.6% to 92.3%)).

Conclusions NEXUS II had high sensitivity, similar to the derivation study. However, approximately half of unimaged patients were positive for NEXUS II risk criteria; this may result in an increased CT rate in a setting with high clinician accuracy.

Original languageEnglish
Pages (from-to)4-11
Number of pages8
JournalEmergency Medicine Journal
Volume36
Issue number1
DOIs
Publication statusPublished - Jan 2019

Cite this

@article{8d6b6927ad814cf4b60b27e030bfd8d0,
title = "Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study",
abstract = "Objective The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.Methods We performed a prospective observational study of patients agedResults Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8{\%}), of whom 377 (19.2{\%}) had ICI as defined by NEXUS II. 74 (19.6{\%} of ICI) patients underwent neurosurgery.Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95{\%} CI 97.3{\%} to 99.7{\%})) and specificity was 9320/19 726 (47.2{\%} (95{\%} CI 46.5{\%} to 47.9{\%})) for the total cohort. Sensitivity in the CT-only cohort was similar. Of the 18 022 children without CT in ED, 49.4{\%} had at least one NEXUS II risk criterion. Sensitivity for ICI by the clinicians without the rule was 377/377 (100.0{\%} (95{\%} CI 99.0{\%} to 100.0{\%})) and specificity was 18 147/19 732 (92.0{\%} (95{\%} CI 91.6{\%} to 92.3{\%})).Conclusions NEXUS II had high sensitivity, similar to the derivation study. However, approximately half of unimaged patients were positive for NEXUS II risk criteria; this may result in an increased CT rate in a setting with high clinician accuracy.",
keywords = "COMPUTED-TOMOGRAPHY, RADIATION-EXPOSURE, INSTRUMENT, METHODOLOGY, PERFORMANCE, CHALICE, PECARN, CATCH",
author = "{Paediat Res Emergency Dept Int} and Babl, {Franz E.} and Ed Oakley and Dalziel, {Stuart R.} and Borland, {Meredith L.} and Natalie Phillips and Amit Kochar and Sarah Dalton and Cheek, {John Alexander} and Yuri Gilhotra and Jeremy Furyk and Jocelyn Neutze and Susan Donath and Stephen Hearps and Crowe, {Louise M.} and Marta Arpone and Silvia Bressan and Lyttle, {Mark D.}",
year = "2019",
month = "1",
doi = "10.1136/emermed-2017-207435",
language = "English",
volume = "36",
pages = "4--11",
journal = "Emergency Medicine Journal",
issn = "1472-0205",
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}

Accuracy of NEXUS II head injury decision rule in children : a prospective PREDICT cohort study. / Paediat Res Emergency Dept Int.

In: Emergency Medicine Journal, Vol. 36, No. 1, 01.2019, p. 4-11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Accuracy of NEXUS II head injury decision rule in children

T2 - a prospective PREDICT cohort study

AU - Paediat Res Emergency Dept Int

AU - Babl, Franz E.

AU - Oakley, Ed

AU - Dalziel, Stuart R.

AU - Borland, Meredith L.

AU - Phillips, Natalie

AU - Kochar, Amit

AU - Dalton, Sarah

AU - Cheek, John Alexander

AU - Gilhotra, Yuri

AU - Furyk, Jeremy

AU - Neutze, Jocelyn

AU - Donath, Susan

AU - Hearps, Stephen

AU - Crowe, Louise M.

AU - Arpone, Marta

AU - Bressan, Silvia

AU - Lyttle, Mark D.

PY - 2019/1

Y1 - 2019/1

N2 - Objective The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.Methods We performed a prospective observational study of patients agedResults Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had ICI as defined by NEXUS II. 74 (19.6% of ICI) patients underwent neurosurgery.Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95% CI 97.3% to 99.7%)) and specificity was 9320/19 726 (47.2% (95% CI 46.5% to 47.9%)) for the total cohort. Sensitivity in the CT-only cohort was similar. Of the 18 022 children without CT in ED, 49.4% had at least one NEXUS II risk criterion. Sensitivity for ICI by the clinicians without the rule was 377/377 (100.0% (95% CI 99.0% to 100.0%)) and specificity was 18 147/19 732 (92.0% (95% CI 91.6% to 92.3%)).Conclusions NEXUS II had high sensitivity, similar to the derivation study. However, approximately half of unimaged patients were positive for NEXUS II risk criteria; this may result in an increased CT rate in a setting with high clinician accuracy.

AB - Objective The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort.Methods We performed a prospective observational study of patients agedResults Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had ICI as defined by NEXUS II. 74 (19.6% of ICI) patients underwent neurosurgery.Sensitivity for ICI based on the NEXUS II CDR was 379/383 (99.0 (95% CI 97.3% to 99.7%)) and specificity was 9320/19 726 (47.2% (95% CI 46.5% to 47.9%)) for the total cohort. Sensitivity in the CT-only cohort was similar. Of the 18 022 children without CT in ED, 49.4% had at least one NEXUS II risk criterion. Sensitivity for ICI by the clinicians without the rule was 377/377 (100.0% (95% CI 99.0% to 100.0%)) and specificity was 18 147/19 732 (92.0% (95% CI 91.6% to 92.3%)).Conclusions NEXUS II had high sensitivity, similar to the derivation study. However, approximately half of unimaged patients were positive for NEXUS II risk criteria; this may result in an increased CT rate in a setting with high clinician accuracy.

KW - COMPUTED-TOMOGRAPHY

KW - RADIATION-EXPOSURE

KW - INSTRUMENT

KW - METHODOLOGY

KW - PERFORMANCE

KW - CHALICE

KW - PECARN

KW - CATCH

U2 - 10.1136/emermed-2017-207435

DO - 10.1136/emermed-2017-207435

M3 - Article

VL - 36

SP - 4

EP - 11

JO - Emergency Medicine Journal

JF - Emergency Medicine Journal

SN - 1472-0205

IS - 1

ER -