Oman et al reported a NEXUS head CT decision instrument for pediatric blunt head trauma. The original 8 criteria of the NEXUS criteria included older age, which is not suitable for pediatric patients.

Patient selection: pediatric patient with blunt head injury


Outcome: ordering of head CT


Criteria for pediatric patients - one or more of the following:

(1) evidence of skull fracture (basilar, depressed, diastatic, etc)

(2) scalp hematoma (over the calvarium; do not include hematomas of face or neck)

(3) neurologic deficit (motor or sensory deficits, cerebellar signs, abnormal gait, abnormal weakness, etc)

(4) abnormal level of alertness (Glasgow coma score <= 14, delayed or inappropriate response to external stimulus, excessive somnolence, disorientation, inability to remember 3 objects at 5 minutes; perseverating speech, etc)

(5) abnormal behavior (inappropriate action, agitation, inconsolability, refusal to cooperate, etc)

(6) persistent vomiting (>= 2 episodes of projectile or forceful emesis)

(7) coagulopathy (impairment of normal clotting)



Signs of basilar skull fracture: periorbital or periauricular ecchymoses; hemotympanum; drainage of CSF from nose or ears

Signs of depressed skull fracture: palpable step-off of the skull; stellate laceration; injury from an object striking a localized region of the skull


A pediatric patient with none of the criteria is unlikely to have a "significant" finding on head CT. This does not mean that the head CT would be completely normal.

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