Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The NEXUS criteria for chest X-ray assessment in cases of blunt chest trauma is designed to evaluate the risk of significant intrathoracic injury by scoring specific risk factors. Each factor is assigned an equal weighting. The factors considered and their respective conditions are as follows:

- Age greater than 60 years
- Involvement in a rapid deceleration accident, such as falling more than 6 meters or being in a motor vehicle crash traveling faster than 64 km/hour
- Experiencing chest pain
- Presence of intoxication
- Altered mental status
- Presence of distracting painful injury
- Notable chest wall tenderness

These inputs are evaluated as true or false, resulting in a score of either 1 or 0 for each factor, respectively. The scores from all these factors are summed to yield a total score, which ranges from 0 to 7.

The interpretation of these scores is straightforward:

- If the total score is 0, the risk of significant intrathoracic injury is considered low, and thus, imaging is generally not required.
- Conversely, a score of 1 or higher signals a heightened risk of significant intrathoracic injury, warranting consideration of imaging to assess the injured area further.

The NEXUS Chest Decision Instrument (NEXUS Chest X-ray) is a clinical calculator used in the evaluation of patients who have experienced blunt chest trauma. This scoring system is designed to identify patients who are at low risk of injury and therefore may not require imaging, specifically chest X-ray, thus reducing unnecessary radiation exposure and healthcare costs.

The NEXUS Chest X-ray is applicable to patients who have sustained blunt chest trauma, often due to incidents such as motor vehicle accidents, falls, or physical assaults. 

The clinical utility of this calculator is to aid in the decision-making process of whether a chest X-ray is necessary, based on the presence or absence of certain criteria. These criteria include age over 60, rapid deceleration mechanism, chest pain, intoxication, altered mental status, distracting painful injury, and tenderness in the chest wall, sternum, thoracic spine, or scapula.

Patients who do not meet any of these criteria are considered at low risk for significant injury and may not require a chest X-ray. However, the decision to forego imaging should always be made in conjunction with clinical judgment. 

The NEXUS Chest X-ray should not be used in patients with penetrating chest trauma, those with a known history of chest injury or

Blunt cardiac injury

Background

Overview

Guidelines

Key sources