Background

Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (NEXUS Head CT decision instrument) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients.

Methods

We conducted a prospective observational study of the NEXUS Head CT decision instrument (DI) that requires patients to meet eight criteria to achieve “low-risk” classification. We examined the instrument’s performance in identifying patients requiring neurological intervention from among a cohort of 11,770 blunt head injury patients.

Results

The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurological intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1% – 100.0%]). The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurological intervention (specificity, 24.9% [95% CI: 24.1% - 25.7%]). None of the 2,823 low-risk patients required neurological intervention (NPV, 100.0% [95% CI: 99.9% - 100.0%]).

The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0% - 99.6%]). The instrument assigned low-risk status to 2,815 of 11,003 patients who did not have significant injuries (specificity, 25.6% [95% CI: 24.8% - 26.4%]). Significant injuries were absent in 2,815 of the 2,823 patients assigned low-risk status (NPV, 99.7% [95% CI: 99.4% - 99.9%]).

Conclusions

The NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging, and could significantly reducing the use of CT imaging.

Prospective

multicenter