Paediatric NEXUS II Head CT Decision Instrument for Blunt Trauma
The NEXUS II head CT decision instrument applied to children (Oman 2006). Of its 8 criteria, age 65 or over does not apply to children, leaving 7. All absent = low risk of clinically important intracranial injury.
Score interpretation
No NEXUS II criteria present -- very low risk for intracranial injury
→ CT head not required; 4-6 hours ED observation; serial GCS and neuro observations; written head injury discharge advice; return if: persistent headache, repeated vomiting, seizure, excessive drowsiness, confusion, focal weakness, clear fluid from nose or ears; adult supervision for 24-48 hours; no sport for minimum 2 weeks or until symptom-free; use PECARN tool as primary decision rule when available -- NEXUS II is complementary.
One or more NEXUS II criteria present -- CT head required
→ CT head without contrast urgently (within 1 hour if GCS < 15 or focal deficit; within 8 hours otherwise); paediatric surgery/neurosurgery consultation if positive CT; admit all with intracranial injury; GCS, pupils, and neuro obs every 30 minutes; senior paediatric review; if GCS < 9: immediate anaesthesia/PICU assessment; analgesia; anti-emetics; glucose monitoring; consider NAI if injury pattern inconsistent with history.
Interpretation bands for the Paediatric NEXUS II. Apply clinical judgement and local guidance.
References
- Oman JA et al. Performance of a decision rule to predict need for computed tomography among children with blunt head trauma. Pediatrics. 2006;117(2):e238-246.
- Mower WR et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59(4):954-959.
- NICE NG232. Head injury: assessment and early management. NICE. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Vancomycin (Paediatric) · Glycopeptide Antibiotic — MRSA / Severe Gram-Positive Infections in Children
- Iron Supplementation (Paediatric) · Iron Supplement — Iron Deficiency Anaemia in Children
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.