Comparison of Diagnostic Accuracy of NEXUS Chest and Thoracic Injury Rule-Out Criteria in Patients with Blunt Trauma; A Cross-Sectional Study

Document Type : Original Article


1 Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran



Background: Blunt chest trauma is the third most important injury in patients with multiple trauma, thus the appropriate diagnosis is critical. Although chest X-rays (CXRs) are the most common diagnostic method, the physician should detect the imaging necessity and modality. Accordingly, NEXUS chest and thoracic injury rule-out criteria (TIRC) have been developed to prevent unnecessary radiographs in traumatized patients.
Objectives: In this study, the diagnostic accuracy of these two guidelines was compared in patients with multiple trauma.
Methods: In this cross-sectional study, eligible patients with chest blunt trauma, who referred to the Emergency Department of Imam Hossein Hospital from July 2016 to March 2018, were recruited. Demographic data, trauma and clinical information, and radiographic reports were recorded and the necessity of CXR was determined based on NEXUS chest and TIRC. Finally, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated for NEXUS chest and TIRC.
Results: In this study, 1925 patients with a mean age of 43.7 ± 9.16 years were evaluated (55% male). The sensitivity, specificity, PPV, NPV of TIRC in the diagnosis of traumatic chest injury were 93.6%, 84.9%, 24.03%, and 99.6%, respectively, and those of NEXUS in the diagnosis of traumatic chest injuries were 97.84%, 51.80%, 93.43%, and 99.79%, respectively. There was no significant difference in diagnostic accuracy between TIRC and NEXUS chest models.
Conclusions: This study showed that NEXUS chest and TIRC have equal values in predicting traumatized chest injuries. Parameters of TIRC are easily measurable in ED and do not require subjective assessments, such as mechanisms and velocity of trauma or fall height. Therefore, the TIRC model seems to be a better tool than NEXUS in detecting injury to the chest and reducing the risk of radiation exposure.