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. 2023 Jun;13(2):52-57.
doi: 10.1016/j.afjem.2023.02.003. Epub 2023 Mar 9.

Comparative study of National Emergency X-Radiography Utilization Study (NEXUS) chest algorithm and extended focused assessment with sonography for trauma (E-FAST) in the early detection of blunt chest injuries in polytrauma patients

Yasmin Z Attia  1 , Nashwa M Abd Elgeleel  1 , Hazem M El-Hariri  2 , Gouda M Ellabban  3 , Maged El-Setouhy  4   5   6 , Jon Mark Hirshon  7 , Adel H Elbaih  1 , Mohamed El-Shinawi  7   8   9
Affiliations

Comparative study of National Emergency X-Radiography Utilization Study (NEXUS) chest algorithm and extended focused assessment with sonography for trauma (E-FAST) in the early detection of blunt chest injuries in polytrauma patients

Yasmin Z Attia et al. Afr J Emerg Med. 2023 Jun.

Abstract

Introduction: Chest imaging plays a prominent role in the assessment of patients with blunt trauma. Selection of the right approach at the right time is fundamental in the management of patients with blunt chest trauma.[1] A reliable, economic, bedside, and rapidly accomplished screening test can be pivotal. [2].

Objective: The aim of this study was to compare the accuracy of extended- focused assessment with sonography for trauma (E-FAST) to that of the National Emergency X-Radiography Utilisation Study (NEXUS) chest algorithm in detecting blunt chest injuries.

Methods: This descriptive cross-sectional study included 50 polytrauma patients with blunt chest trauma from the emergency centre of Suez Canal University Hospital. E-FAST and computed tomography (CT) were conducted, followed by reporting of NEXUS criteria for all patients. Blinding of the E-FAST performer and CT reporter were confirmed. The results of both the NEXUS algorithm and E-FAST were compared with CT chest results.

Results: The NEXUS algorithm had 100% sensitivity and 15.3% specificity, and E-FAST had 70% sensitivity and 96.7% specificity, in the detection of pneumothorax.In the detection of hemothorax, the sensitivity and specificity of the NEXUS algorithm were 90% and 7.5%, respectively, whereas E-FAST had a lower sensitivity of 80% and a higher specificity of 97.5%.

Conclusion: E-FAST is highly specific for the detection of hemothorax, pneumothorax, and chest injuries compared with the NEXUS chest algorithm, which demonstrated the lowest specificity. However, the NEXUS chest algorithm showed a higher sensitivity than E-FAST and hence can be used effectively to rule out thoracic injury.

Keywords: Blunt chest trauma; E-FAST; Hemothorax; NEXUS; Pneumothorax.

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Conflict of interest statement

This work was funded by the National Institutes of Health, Fogarty International Center, Bethesda, MD (grant number, 2D43TW007296). The authors declare that they have no other competing interests.

Figures

Fig 1
Fig. 1
NEXUS Chest Decision Instrument Implementation
See this image and copyright information in PMC

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