NEXUS Chest CT Rule

Background

  • 8 United States level 1 trauma centers enrolled patients for derivation and validation of a decision instrument to aid in the decision to perform a chest CT in patients with blunt trauma.[1]
  • The rule has two sub-rules, one for detection of major injuries, and one for detection of all injuries (major and minor injuries) in hemodynamically stable, non-intubated patients

CT Major Injury Rule

May not need a CT if all criteria are absent

  1. Abnormal CXR
  2. Distracting injury
  3. Chest wall tenderness
  4. Sternum tenderness
  5. Thoracic spine tenderness
  6. Scapula tenderness

CT All Injuries Rule

May not need a CT if all criteria are absent

  1. Abnormal CXR
  2. Distracting injury
  3. Chest wall tenderness
  4. Sternum tenderness
  5. Thoracic spine tenderness
  6. Scapula tenderness
  7. Rapid deceleration mechanism

Sensitivity

CT-Major Injury Rule

  • 99 sensitive for major injuries
  • 90% sensitive for minor injuries

CT-All Injury Rule

  • 99% sensitive for major injuries
  • 95% sensitive for minor injuries.

See Also

External Links

References

  1. ↑ Rodriguez, RM et al. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT). PLoS Med. 2015 Oct 6;12(10):e1001883.full text
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