🧠 NEXUS-II Criteria for Head CT in Blunt Head Trauma
Purpose: To identify patients with blunt head trauma (GCS ≥13) who are at low risk for clinically significant intracranial injury (ICI) and may not require head CT.
A Head CT is recommended if ANY of the following are present: - Evidence of significant skull fracture (e.g., basilar signs, palpable step-off) - Scalp hematoma - Neurological deficit - Altered level of alertness - Abnormal behavior - Coagulopathy - Persistent vomiting - Age ≥ 65 years
Inclusion Criteria:
- Blunt head trauma
- GCS ≥ 13
- Age ≥ 1 year
- Stable vital signs
Performance:
- Sensitivity: ~98–99% (excellent for ruling out significant injury)
- Specificity: Low (many unnecessary scans avoided only if used judiciously)
📊 Comparison with Other Head CT Rules
| Rule | GCS Range | Focus | Sensitivity | Specificity |
|---|---|---|---|---|
| NEXUS-II | ≥13 | Safety net, easy to apply | Very high | Low |
| CCHR | 13–15 | High-risk neurosurgical signs | High | Moderate |
| NOC | 15 | Symptom-based | Very high | Low |
Clinical Tip: NEXUS-II is a broad and highly sensitive rule that helps rule out the need for CT in patients with no red flags. Especially valuable in busy EDs or resource-limited settings.