NEXUS Head CT

BackgroundClinicians, 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.MethodsWe 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.ResultsThe 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...