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.
• 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

Nexus chest CT in trauma rule (major injury)

CT if any one of the following:

• Abnormal CXR
• Distracting injury
• Tenderness of:
  • Chest wall
  • Sternum
  • Thoracic spine
  • Scapula

Sensitivity

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

Nexus chest CT in trauma rule (minor injury)

CT if any one of the following:

• Abnormal CXR
• Distracting injury
• Tenderness of:
  • Chest wall
  • Sternum
  • Thoracic spine
  • Scapula
• Rapid deceleration mechanism

Sensitivity

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

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

• NEXUS cervical spine rule
• Thoracic trauma