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

NEXUS criteria for chest X-ray in blunt chest trauma

The Blast Lung Injury severity score calculator assesses injury severity using three key parameters from clinical evaluations.

For the arterial partial pressure of oxygen to fraction of inspired oxygen ratio, scores are assigned as follows:
- Greater than 200 scores 0.
- Between 60 and 200 scores 1.
- Less than 60 scores 2.

Chest X-ray findings are categorized as:
- Localized lung infiltrates, scoring 0.
- Bilateral or unilateral lung infiltrates, scoring 1.
- Massive bilateral lung infiltrates, scoring 2.

For the presence of a bronchial pleural fistula:
- Yes scores 1.
- No scores 0.

To calculate the blast injury severity score, simply add together the scores for these three inputs. The total score will fall between 0 and 5, which reflects the severity of the condition. A score of 0 indicates mild blast lung injury, a score from 1 to 4 suggests moderate injury, and a score of 5 denotes severe injury. The interpretation of the score helps guide clinical decisions on managing blast lung injuries effectively.

The Blast Lung Injury Severity Score (BLISS) is a clinical calculator used in the assessment of patients who have been exposed to a blast injury, specifically focusing on lung injury. This scoring system is particularly applicable to military personnel, victims of terrorist attacks, or individuals involved in industrial accidents where an explosion has occurred. 

The BLISS is used to quantify the severity of a blast lung injury, which can help guide treatment decisions and provide prognostic information. It takes into account factors such as the patient's oxygenation, lung compliance, and the presence of pneumothorax or hemothorax. 

Exclusion criteria for the use of the BLISS include patients who have not been exposed to a blast injury, or those with pre-existing lung conditions that could confound the assessment of a new blast injury. It's also important to note that the BLISS should be used in conjunction with a comprehensive clinical assessment, and not as a standalone diagnostic tool.

Blast Lung Injury severity score

Blunt chest trauma

Management of aortic injury

Management of aortic injury, aortic repair, timing

Management of aortic injury, expectant management

Management of pulmonary contusion

Management of pulmonary contusion (diuretics)

Management of pulmonary contusion (respiratory support)

Management of aortic injury, anti-impulse therapy

Technical considerations for chest drainage

Technical considerations for chest drainage, antibiotic prophylaxis

As per AAST/GAIS/SIS-E/…/WSIS 2024 guidelines, 

Management of aortic injury, left subclavian artery revascularization

Evaluation for cardiac injury

Evaluation for cardiac injury, imaging

Management of pulmonary contusion (chest physiotherapy)

Evaluation for pneumothorax/hemothorax

Management of pulmonary contusion (corticosteroids)

Management of aortic injury, aortic repair, indications

Evaluation for renal injury

Evaluation for aortic injury

Pediatric patients

Management of aortic injury, aortic repair, choice of approach

Management of pain

Management of aortic injury, aortic repair, technical considerations

Noninvasive ventilation

Management of aortic injury, resuscitative endovascular balloon aortic occlusion

Management of aortic injury, setting of care

Management of aortic injury (resuscitative thoracotomy)

Management of aortic injury (repair of aortic arch vessels)

Initial evaluation

Evaluation for cardiac injury (ECG)

Blood product transfusion

Evaluation for rib fracture

Management of pneumothorax

Management of pneumothorax (drainage)

Technical considerations for chest drainage (care of inserted drains)

Indications for surgery

Technical considerations for chest drainage (insertion technique)

Technical considerations for chest drainage, follow-up imaging

Management of aortic injury (tranexamic acid)

Management of aortic injury, surveillance imaging

Management of rib fracture

Management of rib fracture, surgical stabilization

Management of rib fracture, analgesics

Mechanical ventilation

Management of pulmonary contusion (analgesics)

Evaluation for cardiac injury (cardiac biomarkers)

Management of pneumothorax (oxygen supplementation)

Management of pulmonary contusion (fluid resuscitation)

Management of hemothorax

Antibiotic prophylaxis

Technical considerations for chest drainage (analgesic premedication)

Updated 2024 EACTS/STS guidelines for the management of blunt traumatic aortic injury


Updated 2024 ACEP guidelines for the evaluation and management of acute blunt trauma


Blunt chest trauma

Background

Overview

Guidelines

Key sources