ToolsCalculators
NEXUS Chest Decision Instrument for blunt chest trauma
Identifies blunt-trauma patients who can forgo chest imaging.
NEXUS Chest Decision Instrument for blunt chest trauma
Age > 60 years
Rapid deceleration mechanism (fall > 6 m / MVC > 65 km/h)
Chest pain
Intoxication
Altered alertness or mental status
Distracting painful injury
Chest-wall tenderness on palpation
ResultNo criteria met
No criteria present — thoracic imaging can be safely deferred (sensitivity ~99% for clinically significant injury).
When to use
- Deciding whether a stable adult blunt-trauma patient needs chest imaging.
Formula
Seven criteria: age > 60, rapid deceleration, chest pain, intoxication, altered mental status, distracting injury, chest-wall tenderness. Imaging can be deferred only if none are present.
Pearls and pitfalls
- Derived and validated to keep sensitivity high for clinically significant thoracic injury at the cost of specificity.