Validation of NEXUS Chest Criteria in Chest Trauma Patients - A Prospective Observational Study

Background: Traumatic injuries significantly impact morbidity, mortality, and healthcare costs, particularly in developing countries like India. Thoracic injuries contribute to 20-50% of trauma-related deaths. The NEXUS chest criteria aim to reduce unnecessary radiological imaging, thereby saving time, reducing costs, and minimizing radiation exposure. Aim: To determine the diagnostic accuracy of NEXUS chest criteria in predicting traumatic thoracic injuries in an Indian context. Objective: To evaluate the sensitivity, specificity, negative predictive value, and positive predictive value of NEXUS chest criteria. Design, Setting, and Participants: A prospective observational study was conducted at KIMSHEALTH Thiruvananthapuram from March 2021 to July 2022, involving 122 trauma patients aged over 18 years. Physicians recorded the presence of NEXUS Chest 7 clinical criteria before viewing radiographic results. Method: The NEXUS chest criteria were applied to the study population, and results were compared with chest x-ray findings to determine sensitivity. Results: Among 122 patients (mean age 42.90 years, 63.1% male), 53.3% injuries were due to RTA. Chest x-ray was indicated in 53 patients, revealing thoracic injuries in 43. The NEXUS chest criteria showed a sensitivity of 90.7%, specificity of 97.5%, positive predictive value of 50%, and negative predictive value of 100%. The diagnostic accuracy was 97.5%. Conclusion: NEXUS Chest criteria effectively reduce the need for chest imaging in blunt trauma patients over 18 years old.