DR SAIMA SIDDIQUI , DR MUNAWWAR KHURSHEED , DR MARVI , DR SANOBER SIKANDAR , DR NOSHEEN RAUF
DOI: https://doi.org/Background: Prompt recognition of thoracic injuries in patients with blunt trauma remains critical for guiding imaging and treatment. The National Emergency X-Radiography Utilization Study (NEXUS) Chest decision instrument was designed to identify patients at low risk for significant thoracic injury and reduce unnecessary imaging. We aimed to determine its diagnostic accuracy against chest imaging as the gold standard in a tertiary care hospital.
Methods: We carried out a cross-sectional study of 134 blunt trauma patients who underwent both NEXUS Chest assessment and chest imaging. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, using chest imaging as the reference standard.
Results: The NEXUS Chest instrument correctly classified 82 patients as true positives and 25 as true negatives, with 10 false positives and 17 false negatives. It achieved a sensitivity of 73.9%, specificity of 71.4%, PPV of 89.1%, NPV of 59.5%, and an overall diagnostic accuracy of 79.8%. The tool reliably confirmed injury when present but showed limited ability to rule out injury when negative.
Conclusion: NEXUS Chest provides good diagnostic accuracy for detecting thoracic injuries in blunt trauma, particularly when confirming injury. Clinicians should interpret negative results cautiously, especially in high-risk patients. Combining NEXUS Chest with adjunctive modalities such as extended focused assessment with sonography for trauma (E-FAST) may enhance diagnostic precision and support safe, efficient imaging decisions in tertiary care settings.
