{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T09:40:42Z","timestamp":1772271642413,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T00:00:00Z","timestamp":1470009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of California Center for Health Quality and Innovation (CHQI)"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2016,8]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>The use of chest computed tomography (CT<\/jats:styled-content>) to evaluate emergency department patients with adult blunt trauma is rising. The NEXUS<\/jats:styled-content> Chest CT<\/jats:styled-content> decision instruments are highly sensitive identifiers of adult blunt trauma patients with thoracic injuries. However, many patients without injury exhibit one of more of the criteria so cannot be classified \u201clow risk.\u201d We sought to determine screening performance of both individual and combined NEXUS<\/jats:styled-content> Chest CT<\/jats:styled-content> criteria as predictors of thoracic injury to inform chest CT<\/jats:styled-content> imaging decisions in \u201cnon\u2013low\u2010risk\u201d patients.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a secondary analysis of data on patients in the derivation and validation cohorts of the prospective, observational NEXUS<\/jats:styled-content> Chest CT<\/jats:styled-content> study, performed September 2011 to May 2014 in 11 Level I trauma centers. Institutional review board approval was obtained at all study sites. Adult blunt trauma patients receiving chest CT<\/jats:styled-content> were included. The primary outcome was injury and major clinical injury prevalence and screening performance in patients with combinations of one, two, or three of seven individual NEXUS<\/jats:styled-content> Chest CT<\/jats:styled-content> criteria.<\/jats:p><\/jats:sec>Results<\/jats:title>Across the 11 study sites, rates of chest CT<\/jats:styled-content> performance ranged from 15.5% to 77.2% (median = 43.6%). We found injuries in 1,493\/5,169 patients (28.9%) who had chest CT<\/jats:styled-content>; 269 patients (5.2%) had major clinical injury (e.g., pneumothorax requiring chest tube). With sensitivity of 73.7 (95% confidence interval [CI<\/jats:styled-content>] = 68.1 to 78.6) and specificity of 83.9 (95% CI<\/jats:styled-content> = 83.6 to 84.2) for major clinical injury, abnormal chest\u2010x\u2010ray (CXR<\/jats:styled-content>) was the single most important screening criterion. When patients had only abnormal CXR<\/jats:styled-content>, injury and major clinical injury prevalences were 60.7% (95% CI<\/jats:styled-content> = 52.2% to 68.6%) and 12.9% (95% CI<\/jats:styled-content> = 8.3% to 19.4%), respectively. Injury and major clinical injury prevalences when any other single criterion alone (other than abnormal CXR<\/jats:styled-content>) was present were 16.8% (95% CI<\/jats:styled-content> = 15.2% to 18.6%) and 1.1% (95% CI<\/jats:styled-content> = 0.1% to 1.8%), respectively. Injury and major clinical injury prevalences among patients when two and three criteria (not abnormal CXR<\/jats:styled-content>) were present were 25.5% (95% CI<\/jats:styled-content> = 23.1% to 28.0%) and 3.2% (95% CI<\/jats:styled-content> = 2.3% to 4.4%) and 34.9% (95% CI<\/jats:styled-content> = 31.0% to 39.0%) and 2.7% (95% CI<\/jats:styled-content> = 1.6% to 4.5%), respectively.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>We recommend that clinicians check for the six clinical NEXUS<\/jats:styled-content> Chest CT<\/jats:styled-content> criteria and review the CXR<\/jats:styled-content> (if obtained). If patients have one clinical criterion (other than abnormal CXR<\/jats:styled-content>), they will have a very low risk of clinically major injury. We recommend that clinicians discuss the potential risks and benefit of chest CT<\/jats:styled-content> in these cases. The risks of injury and major clinical injury rise incrementally with more criteria, rendering the risk\/benefit ratio toward performing CT<\/jats:styled-content> in most cases. If the patient has an abnormal CXR<\/jats:styled-content>, the risks of major clinical injury and minor injury are considerably higher than with the other criteria\u2014chest CT<\/jats:styled-content> may be indicated in cases requiring greater anatomic detail and injury characterization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13010","type":"journal-article","created":{"date-parts":[[2016,5,10]],"date-time":"2016-05-10T15:42:41Z","timestamp":1462894961000},"page":"863-869","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Prevalence and Diagnostic Performance of Isolated and Combined NEXUS<\/scp> Chest CT<\/scp> Decision Criteria"],"prefix":"10.1111","volume":"23","author":[{"given":"Ali S.","family":"Raja","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital and Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William R.","family":"Mower","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel K.","family":"Nishijima","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California Davis CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory W.","family":"Hendey","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine San Francisco Fresno Medical Education Program San Francisco CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigitte M.","family":"Baumann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony J.","family":"Medak","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California at San Diego School of Medicine San Diego CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California San Francisco CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1408"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10100640"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-006-0493-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.141.5.468"},{"key":"e_1_2_7_6_1","volume-title":"Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2","author":"Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council","year":"2006"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.07.078"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.2757"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001883"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007133430203"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61558-0"},{"key":"e_1_2_7_12_1","article-title":"Prevalence of chest injury with the presence of NEXUS chest criteria: data to inform shared decision making about imaging use","author":"Raja AS","year":"2015","journal-title":"Ann Emerg Med"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.10.001"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181f2ac9d"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-009-1608-y"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60232-4"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-014-0054-2"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.07.005"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.06.003"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-3-200602070-00009"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181b5f2eb"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.03.011"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.13010","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.13010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T19:19:16Z","timestamp":1695755956000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.13010"}},"subtitle":[],"editor":[{"given":"Erik P.","family":"Hess","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2016,8]]},"references-count":21,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2016,8]]}},"alternative-id":["10.1111\/acem.13010"],"URL":"https:\/\/doi.org\/10.1111\/acem.13010","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8]]},"assertion":[{"value":"2015-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-04-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-08-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}