NEXUS chest: blunt trauma
Identifies very low risk of thoracic injury seen on imaging in blunt trauma, from the seven criteria.
When to use
Blunt chest trauma in an adult, to identify who has very low risk of injury on imaging and can skip it.
Pearls and pitfalls
- The rule was assessed in patients over 14 years with blunt trauma evaluated within 24 hours.
- Without any criterion imaging is not indicated; with any criterion the injury cannot be excluded and imaging enters the assessment.
- Age over 60 counts as one criterion, so age enters as a number rather than a separate question.
- The rule selects who needs chest imaging, not which study to order: radiography or computed tomography is left to clinical assessment and to dedicated instruments.
- In validation, sensitivity was 98.8% and specificity 13.3% for thoracic injury seen on imaging, so the rule excludes injury and does not confirm it.
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Formula
Sum of age over 60, rapid deceleration, chest pain, intoxication, abnormal alertness, distracting injury and chest wall tenderness.
Evidence
Decision rule for imaging in blunt chest trauma, compared with ultrasound for detecting chest injuries.
References
- Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940-946. doi:10.1001/jamasurg.2013.2757
- Attia YZ, Elgeleel NMA, El-Hariri HM, et al. Comparative study of NEXUS chest algorithm and extended focused assessment with sonography for trauma in the early detection of blunt chest injuries in polytrauma patients. Afr J Emerg Med. 2023;13(2):80-86. doi:10.1016/j.afjem.2023.02.003
Frequently asked questions
What is NEXUS chest: blunt trauma?
Identifies very low risk of thoracic injury seen on imaging in blunt trauma, from the seven criteria. Blunt chest trauma in an adult, to identify who has very low risk of injury on imaging and can skip it.
How is the result calculated?
Sum of age over 60, rapid deceleration, chest pain, intoxication, abnormal alertness, distracting injury and chest wall tenderness.
How should the result be interpreted?
Decision rule for imaging in blunt chest trauma, compared with ultrasound for detecting chest injuries.
What are the sources?
Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940-946. Attia YZ, Elgeleel NMA, El-Hariri HM, et al. Comparative study of NEXUS chest algorithm and extended focused assessment with sonography for trauma in the early detection of blunt chest injuries in polytrauma patients. Afr J Emerg Med. 2023;13(2):80-86.