NEXUS Chest Decision Instrument for Blunt Chest Trauma

Assess the need for chest imaging after blunt trauma


The NEXUS Chest decision instrument for blunt chest trauma is a validated tool which may safely reduce the need for chest imaging in blunt trauma patients older than 14 years.

The decision tool was developed as chest imaging (CXR and CT) is the most common imaging in blunt trauma assessment and there is an interest in avoiding unnecessary imaging due to the impact on costs, emergency department time, and radiation exposure.

Patients with none of the following were found to be very low risk of thoracic injury seen on chest imaging (TICI):

  • older than 60 years
  • rapid deceleration mechanism (defined as a fall >20 ft / >6.0 m or motor vehicle crash >40 mph / >64 km/h)
  • chest pain
  • intoxication
  • abnormal alertness/mental status
  • distracting painful injury
  • tenderness to chest wall palpation

The sensitivity and negative predictive value for clinically major TICI were 99.7% (95% CI, 98.2%-100.0%) and 99.9% (95% CI, 99.4%-100.0%), respectively.

The sensitivity and negative predictive value for clinically major or minor TICI were 99.0% (95% CI, 98.2%-99.4%) and 98.7% (95% CI, 98.1%-99.3%), respectively.


Rodriguez RM, Hendey GW, Mower W, Kea B, Fortman J, Merchant G, Hoffman JR.

Journal of Trauma 2011, 71 (3): 549-53

Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, Medak AJ, Raja AS, Juhn P, Fortman J, Mulkerin W, Mower WR.

JAMA Surgery 2013, 148 (10): 940-6

Rodriguez RM, Hendey GW, Marek G, Dery RA, Bjoring A.

Annals of Emergency Medicine 2006, 47 (5): 415-8

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