The following is a summary of “Value of NEXUS chest rules in assessment of traumatic chest injuries; a systematic review and a meta-analysis,” published in the March 2023 issue of Emergency Medicine by Ahmadzadeh, et al.

Many studies have examined the usefulness of the NEXUS chest rules in diagnosing traumatic chest injuries, but there still needs to be a consensus on their effectiveness. Therefore, for a study, researchers sought to review the current literature to assess the diagnostic value of the NEXUS chest rules in assessing traumatic chest injuries.

The researchers searched Medline, Embase, Scopus, and Web of Science databases until August 20th, 2022. In addition, two independent reviewers screened articles related to the diagnostic value of NEXUS chest radiography, NEXUS chest CT-all, and NEXUS chest-Major.

The review included data from six studies involving 23,741 patients. Since only one study assessed the NEXUS chest CT scan, the meta-analysis was conducted only on the NEXUS chest radiography rule. Pooled analysis of five studies showed that the NEXUS chest radiography rule had an AUC of 0.98 (95% CI: 0.96 to 0.99) in assessing traumatic chest injuries, with a sensitivity and specificity of 0.99 (95% CI: 0.98 to 0.99) and 0.32 (95% CI: 0.17 to 0.52), respectively. The NEXUS chest radiography rule’s positive and negative likelihood ratios were 1.46 (95% CI: 1.12 to 1.90) and 0.04 (95% CI: 0.03 to 0.06), respectively. The diagnostic odds ratio was 36.67 (95% CI: 19.17 to 70.16).

The NEXUS chest radiography rule was a sensitive decision rule for assessing traumatic chest injuries, but its specificity could be higher. However, more studies were needed to investigate the diagnostic value of NEXUS chest rules, especially the NEXUS chest CT scan, to strengthen the current results.

Reference: sciencedirect.com/science/article/pii/S0735675722007811