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    NEXUS Chest CT Decision Instrument for CT Imaging

    Identifies blunt trauma patients with clinically significant thoracic injuries.
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    INSTRUCTIONS

    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.

    When to Use
    Pearls/Pitfalls
    Why Use

    Blunt trauma patients in whom CT chest is considered as part of the diagnostic evaluation.

    • The NEXUS CT Chest Decision Instrument is comprised of two parts, one that maximizes sensitivity for major injury and the other for major or minor injury.
    • Uses findings from routine trauma exam.
    • 100% sensitive for aortic and great vessel injury (a key component of the rule, as these are devastating injuries that must not be missed).
    • Can be used sequentially with NEXUS Chest Decision Instrument for Blunt Chest Trauma.

    Identifies patients that can safely be ruled out for clinically significant thoracic and intra-thoracic injuries, potentially safely reducing CT scanning by 25-37% in blunt trauma patients.

    Clinically Major Thoracic Injuries
    No
    Yes
    No
    Yes
    No
    Yes
    All Thoracic Injuries
    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    Content Contributors
    • Michael Jones, MD
    About the Creator
    Dr. Robert Rodriguez
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    Content Contributors
    • Michael Jones, MD