Efficacy of the implementation of the National Emergency X-Radiography Utilization Study (NEXUS) II decision rule to clinical practice for pediatric head injury patients.

AIM To investigate the usefulness of the National Emergency X-Radiography Utilization Study (NEXUS) II head trauma decision rule in clinical practice for pediatric patients in a tertiary university hospital serving as the only pediatric hospital in the area. METHODS We compared how doctors evaluated and examined patients with head injury during two time periods; before and after the introduction of NEXUS II decision rule. Multiple implementation strategies were used: education, tutoring and written instructions for the use of NEXUS II. RESULTS 244 head injury patients visited the hospital before and 385 after the introduction of the NEXUS II decision rule. The number of hospital admissions (56%) and the mean duration of hospitalization (2.5d) remained the same during the two periods. In the NEXUS II evaluated group, there was a decrease of 40% in the number of hospital admissions. NEXUS II was applied in only 62 (16%) cases. The number of head imaging procedures remained the same. No patients with a clinically significant head injury were missed with the NEXUS II evaluation. CONCLUSION NEXUS II was ineffective as our implementation failed. When used, NEXUS II reduced expenses in our study population by decreasing the number of hospital admissions.