Value of NEXUS chest rules in assessment of traumatic chest injuries; a systematic review and a meta-analysis.

BACKGROUND

Although many studies have evaluated the diagnostic value of the National Emergency X-ray Utilization Studies (NEXUS) chest rules in assessment of traumatic chest injuries, there still is no consensus on this subject matter. Therefore, this systematic review and meta-analysis aims to review the current existing literature in order to evaluate the diagnostic value of NEXUS chest rules for assessment of traumatic chest injuries.

METHOD: Databases of Medline, Embase, Scopus and Web of Science were searched until August 20th, 2022. Two independent reviewers screened the articles related to the diagnostic value of NEXUS chest radiography, NEXUS chest CT-all and NEXUS chest-Major.

RESULTS

Data of 6 studies, on 23,741 patients, were included in this review. Since only one article assessed the value of NEXUS chest CT scan, the meta-analysis was performed only on NEXUS chest radiography rule. Pooled analysis on the results of 5 articles showed that the AUC of NEXUS chest radiography rule in assessment of traumatic chest injuries was 0.98 (95% CI: 0.96 to 0.99), 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. Positive and negative likelihood ratio of NEXUS chest radiography rule were 1.46 (95% CI: 1.12 to 1.90) and 0.04 (95% CI: 0.03 to 0.06). Overall diagnostic odds ratio was calculated to be 36.67 (95% CI: 19.17 to 70.16).

CONCLUSION

Our findings indicate that NEXUS chest radiography rule is a sensitive decision rule for assessment of traumatic chest injuries, but its specificity was found to be low. However, few articles have investigated the diagnostic value of NEXUS chest rules, especially the NEXUS chest CT scan, and more studies need to be done in order to strengthen the currently provided results.