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

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 ۲۰۱۶ to March ۲۰۱۸, 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, ۱۹۲۵ patients with a mean age of ۴۳.۷ ± ۹.۱۶ years were evaluated (۵۵% male). The sensitivity, specificity, PPV, NPV of TIRC in the diagnosis of traumatic chest injury were ۹۳.۶%, ۸۴.۹%, ۲۴.۰۳%, and ۹۹.۶%, respectively, and those of NEXUS in the diagnosis of traumatic chest injuries were ۹۷.۸۴%, ۵۱.۸۰%, ۹۳.۴۳%, and ۹۹.۷۹%, 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.

Keywords:

Blunt Chest Trauma , Thoracic Injury Rule-Out Criteria , Diagnostic Imaging