MDCalc

NEXUS Chest CT Decision Instrument for CT Imaging

Identifies blunt trauma patients with clinically significant thoracic injuries.

Use in awake, non-intubated, hemodynamically stable blunt trauma patients ≥15 years old in whom a CT chest is considered as part of the normal diagnostic evaluation.

Clinically Major Thoracic Injuries

CXR showing any thoracic injury (including clavicle fracture) or widened mediastinum

All Thoracic Injuries

Fall from >20 feet/6.1 m or MVA at >40 mph/64.4 km/hr with sudden deceleration.

Diagnostic Result

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Advice

If any criteria are positive, major or minor thoracic injury can NOT be excluded, and further workup, including but not limited to CT chest, is warranted.

Management

Should be used in conjunction with standard trauma evaluation and resuscitation.

Critical Actions

Clinical decision tools are meant to assist practitioners with making appropriate and evidence based decisions in the management of patients. The NEXUS CT Chest Decision Instrument suggests that a CT chest can be safely avoided in situations where the provider suspects thoracic injury, is considering CT imaging and answers negatively to the NEXUS CT Chest Decision Instrument. In these situations, the provider can feel confident that significant thoracic and intra-thoracic injuries are not missed.