ToolsCalculators
NEXUS Chest CT decision instrument
Identifies blunt trauma patients in whom chest CT can be safely avoided.
NEXUS Chest CT decision instrument
Abnormal chest X-ray
Any thoracic injury (e.g. pneumothorax, haemothorax, rib or clavicle fracture, pulmonary contusion) or widened mediastinum.
Rapid deceleration mechanism
Fall >6.1 m (20 ft) or motor vehicle crash >64 km/h (40 mph) with sudden deceleration.
Distracting painful injury
Chest wall tenderness
Sternal tenderness
Thoracic spine tenderness
Scapular tenderness
ResultChest CT can be omitted
No criteria present — very low probability of clinically significant thoracic injury; chest CT can be safely avoided.
- Criteria present
- 0 of 7
When to use
- Awake, non-intubated, haemodynamically stable blunt trauma patients aged ≥15 years being considered for chest CT.
Formula
Chest CT-All rule: chest CT indicated if any of 7 criteria are present — abnormal CXR, rapid deceleration mechanism, distracting injury, or chest wall / sternal / thoracic spine / scapular tenderness.
Pearls and pitfalls
- Designed to reduce imaging while retaining near-100% sensitivity for major thoracic injury; it is a rule-out, not a rule-in, tool.
- Any unassessable criterion should be treated as present (i.e. not low risk).