title: Prevalence of Chest Injury With the Presence of NEXUS Chest Criteria: Data to Inform Shared Decisionmaking About Imaging Use.
abstract: The NEXUS chest decision instrument identifies a very-low-risk population of patients with blunt trauma for whom chest imaging can be avoided. However, it requires that all 7 National Emergency X-Ray Utilization Study (NEXUS) chest criteria be absent. To inform patient and physician shared decisionmaking about imaging, we describe the test characteristics of individual criteria of the NEXUS chest decision instrument and provide the prevalence of injuries when 1, 2, or 3 of the 7 criteria are present.
  
  
  
  We conducted this secondary analysis of 2 prospectively collected cohorts of patients with blunt trauma who were older than 14 years and enrolled in NEXUS chest studies between December 2009 and January 2012. Physicians at 9 US Level I trauma centers recorded the presence or absence of the 7 NEXUS chest criteria. We calculated test characteristics of each criterion and combinations of criteria for the outcome measures of major clinical injuries and thoracic injury observed on chest imaging.
  
  
  
  We enrolled 21,382 patients, of whom 992 (4.6%) had major clinical injuries and 3,135 (14.7%) had thoracic injuries observed on chest imaging. Sensitivities of individual test characteristics ranged from 15% to 56% for major clinical injury and 14% to 53% for thoracic injury observed on chest imaging, with specificities varying from 71% to 84% for major clinical injury and 67% to 84% for thoracic injury observed on chest imaging. Individual criteria were associated with a prevalence of major clinical injury between 1.9% and 3.8% and of thoracic injury observed on chest imaging between 5.3% and 11.5%.
  
  
  
  Patients with isolated NEXUS chest criteria have low rates of major clinical injury. The risk of major clinical injury for patients with 2 or 3 factors range from 1.7% to 16.6%, depending on the combination of criteria. Criteria-specific risks could be used to inform shared decisionmaking about the need for imaging by patients and their physicians.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA. Electronic address: asraja@partners.org.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, CA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lanning
authors.affiliation: Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL.
authors.forename: Arian
authors.initials: A
authors.lastname: Gower
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, CA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Langdorf
authors.affiliation: Department of Emergency Medicine, University of California, Davis, CA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.affiliation: Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco Fresno Medical Education Program, San Francisco, CA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hendey
authors.affiliation: Department of Emergency Medicine, University of California, San Diego School of Medicine, San Diego, CA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Medak
authors.affiliation: Department of Emergency Medicine, University of California, Los Angeles, CA.
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, CA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D006801:Humans; D015995:Prevalence; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging*