Validation of the Pediatric <scp>NEXUS II</scp> Head Computed Tomography Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma

Gupta, Malkeet; Mower, William R.; Rodriguez, Robert M.; Hendey, Gregory W.

doi:10.1111/acem.13431

Cited by 12 publications

(20 citation statements)

References 29 publications

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“…It is not clear if a multicentre prospective study of NEXUS II from Korea includes any children 19. Recently, the original team which derived the NEXUS II CDR conducted a validation study in a new data set including 11 750 blunt head injuries20; in an analysis of the paediatric cohort of 1018 children sensitivity was 98.0% (95% CI 89.1% to 99.9%) and specificity of 34.0% (95% CI 31.0% to 37.0%) for the assessment of high-risk status in patients with ICI 21. However, similar to the derivation cohort only patient who had received a CT scan were included in the study.…”

Section: Discussionmentioning

confidence: 99%

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

Babl¹,

Oakley²,

Dalziel

et al. 2018

Emerg Med J

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Section: Discussionmentioning

confidence: 99%

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

Babl¹,

Oakley²,

Dalziel

et al. 2018

Emerg Med J

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“…2 However, a major disadvantage is the exposure of patients to ionizing radiation. 1,7 On the other hand, MRI demonstrates to be less accessible, have higher costs and be less tolerable among younger children when compared to CT. 2,7 However, It is a The NEXUS instrument, for head CT, enabled the identification of pediatric patients with blunt trauma that really needed a CT, which can significantly reduce the use of this imaging examination in children.…”

Section: Resultsmentioning

confidence: 99%

“…An analysis conducted in the USA 1 showed that CT is related to future risks of developing malignanies, 1,11 especially in younger patients, 1 for being an examination that uses ionizing radiation.…”

Section: Nd Category -The Relation Between Ionization and Possible Mmentioning

confidence: 99%

“…However, these resources should be used carefully, together with the clinical judgment from health professionals, so that there is no overuse. 1 Nowadays, due to technological advances, there has been an increase in the use of examinations, especially CTs. This is the physicians' preferred choice in the UEs, because of the fast digitalization of images, which reduces the time of sedation in children.…”

Section: Introductionmentioning

confidence: 99%

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Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Floriani¹,

Borgmann²,

Barreto³

et al. 2022

Rev. paul. pediatr.

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Objective: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. Data sources: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. Data synthesis: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. Conclusions: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children’s exposure to ionizing agents.

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“…The CATCH rule (Canadian Assessment of Tomography for Childhood Head injury) [51] was evaluated in 11 studies [48, 58–61, 63, 66, 72, 81–83]. The NEXUS II rule (National Emergency X-Radiography Utilization Study) [50, 54] was evaluated in four studies [48, 84–86]. Palchak rule [52] was evaluated in two studies [48, 87].…”

Section: Resultsmentioning

confidence: 99%

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Khalifa

Gallego

2019

BMC Emerg Med

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Background Many clinical predictive tools have been developed to diagnose traumatic brain injury among children and guide the use of computed tomography in the emergency department. It is not always feasible to compare tools due to the diversity of their development methodologies, clinical variables, target populations, and predictive performances. The objectives of this study are to grade and assess paediatric head injury predictive tools, using a new evidence-based approach, and to provide emergency clinicians with standardised objective information on predictive tools to support their search for and selection of effective tools. Methods Paediatric head injury predictive tools were identified through a focused review of literature. Based on the critical appraisal of published evidence about predictive performance, usability, potential effect, and post-implementation impact, tools were evaluated using a new framework for grading and assessment of predictive tools (GRASP). A comprehensive analysis was conducted to explain why certain tools were more successful. Results Fourteen tools were identified and evaluated. The highest-grade tool is PECARN; the only tool evaluated in post-implementation impact studies. PECARN and CHALICE were evaluated for their potential effect on healthcare, while the remaining 12 tools were only evaluated for predictive performance. Three tools; CATCH, NEXUS II, and Palchak, were externally validated. Three tools; Haydel, Atabaki, and Buchanich, were only internally validated. The remaining six tools; Da Dalt, Greenes, Klemetti, Quayle, Dietrich, and Güzel did not show sufficient internal validity for use in clinical practice. Conclusions The GRASP framework provides clinicians with a high-level, evidence-based, comprehensive, yet simple and feasible approach to grade, compare, and select effective predictive tools. Comparing the three main tools which were assigned the highest grades; PECARN, CHALICE and CATCH, to the remaining 11, we find that the quality of tools’ development studies, the experience and credibility of their authors, and the support by well-funded research programs were correlated with the tools’ evidence-based assigned grades, and were more influential, than the sole high predictive performance, on the wide acceptance and successful implementation of the tools. Tools’ simplicity and feasibility, in terms of resources needed, technical requirements, and training, are also crucial factors for their success. Electronic supplementary material The online version of this article (10.1186/s12873-019-0249-y) contains supplementary material, which is available to authorized users.

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Validation of the Pediatric NEXUS II Head Computed Tomography Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma

Abstract: The Pediatric NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging and could significantly reduce the use of CT imaging.

Cited by 12 publications

References 29 publications

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

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

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

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