Paediatric NEXUS II Head CT Decision Instrument for Blunt Trauma
Eight-variable clinical decision instrument to identify paediatric blunt head trauma patients at very low risk of brain injury who do not require CT imaging. Validated in the NEXUS II study.
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.
- 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.