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Conference/Presentation Title: | Diagnostic accuracy of the nexus II head injury clinical decision rule in children. a predict prospective cohort study. | Authors: | Dalziel S.R.;Hearps S.;Arpone M.;Oakley E.;Lyttle M.D.;Babl F.E.;Borland M.;Phillips N.;Kochar A.;Dalton S.;Cheek J.A.;Gilhotra Y.;Furyk J.;Neutze J.;Bressan S.;Donath S.;Molesworth C.;Crowe L. | Institution: | (Babl, Borland, Phillips, Kochar, Dalton, Cheek, Gilhotra, Furyk, Neutze, Bressan, Oakley, Dalziel, Lyttle) Paediatric Research in Emergency Departments International Collaborative, Australia (Babl, Borland, Phillips, Kochar, Dalton, Cheek, Gilhotra, Furyk, Neutze, Bressan, Oakley, Lyttle) Paediatric Research in Emergency Departments International Collaborative, New Zealand (Babl, Cheek, Oakley) Emergency Department, Royal Children's Hospital, Melbourne, Australia (Babl, Cheek, Bressan, Donath, Molesworth, Crowe, Hearps, Arpone, Oakley, Lyttle) Murdoch Children's Research Institute, Melbourne, Australia (Babl, Donath, Oakley) Department of Paediatrics, University of Melbourne, Melbourne, Australia (Borland) Emergency Department, Princess Margaret Hospital for Children, Perth, Australia (Borland) Schools of Paediatrics and Child Health and Primary, Aboriginal and Rural H, University of Western Australia, Perth, Australia (Phillips, Gilhotra) Emergency Department, Lady Cilento Children's Hospital, Brisbane, Australia (Kochar) Emergency Department, Women's and Children's Hospital, Adelaide, Australia (Dalton) Emergency Department, Children's Hospital at Westmead, Sydney, Australia (Cheek) Emergency Department, Monash Medical Centre, Melbourne, Australia (Furyk) Emergency Department, Townsville Hospital, Townsville, Australia (Neutze) Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand (Dalziel) Emergency Department, Starship Children's Health, Auckland, New Zealand (Dalziel) Liggins Institute, University of Auckland, Auckland, New Zealand (Lyttle) Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom (Lyttle) Faculty of Health and Applied Science, University of the West of England, Bristol, United Kingdom | Presentation/Conference Date: | 30-Jun-2017 | Copyright year: | 2017 | Publisher: | BMJ Publishing Group | Publication information: | Archives of Disease in Childhood. Conference: Annual Conference of the Royal College of Paediatrics and Child Health, RCPCH 2017. Birmingham United Kingdom. 102 (Supplement 1) (pp A115), 2017. Date of Publication: May 2017. | Abstract: | Aims Clinical decision rules (CDRs) can be applied in Emergency Departments (EDs) to optimise the use of computed tomography (CT) in children with head trauma. The National Emergency XRadiography Utilisation Study II (NEXUS II) CDR, as amended for children, has not been externally validated in a large paediatric cohort. The objective of this study was to conduct a multicentre external validation of the NEXUS II CDR in children. Methods We performed a prospective observational study of patients<18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs. In a planned secondary analysis we assessed the performance of the NEXUS II CDR for its diagnostic accuracy (with 95% confidence intervals (CI)) in predicting clinically important intracranial injury (ICI) as identified in CT scans performed in ED. Results Of 20 137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had a clinically important ICI as defined by NEXUS II. 74 (19.6%) of these patients underwent neurosurgery. Sensitivity for clinically important ICI based on the NEXUS II CDR was 373/377 (98.9%; 97.3%-99.7%) and specificity 156/1585 (9.8%; 8.4%-11.4%). Positive and negative predictive values were respectively 373/1802 (20.7%; 18.8%-22.6%) and 156/160 (97.5%; 93.7%-99.3%). Of the 18 147 children who did not have a CT scan 49.5% had at least one NEXUS II risk criterion. Conclusions NEXUS II had very high sensitivity when analysed with a focus on head injured patients who have had a CT performed, similar to the derivation study. With half of the unimaged patients positive for NEXUS II risk criteria the use of this CDR has the potential to increase the number of CTs. | Conference Start Date: | 2017-05-24 | Conference End Date: | 2017-05-26 | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1136/archdischild-2017-313087.286 | ISSN: | 1468-2052 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/39222 | Type: | Conference Abstract | Subjects: | preschool child child clinical trial computer assisted tomography confidence interval controlled clinical trial controlled study *diagnostic accuracy diagnostic test accuracy study emergency ward *female *head injury human major clinical study *male multicenter study neurosurgery New Zealand observational study penetrating trauma predictive value *prospective study secondary analysis skull *tight junction validation process *prospective study skull *tight junction validation process child clinical trial computer assisted tomography confidence interval controlled clinical trial penetrating trauma predictive value preschool child secondary analysis controlled study *diagnostic accuracy diagnostic test accuracy study emergency ward *female *head injury human major clinical study *male multicenter study neurosurgery New Zealand observational study |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Conferences |
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