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.

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.

• Authors: Yasmin Z Attia, Nashwa M Abd Elgeleel, Hazem M El-Hariri, Gouda M Ellabban, Maged El-Setouhy, Jon Mark Hirshon, Adel H Elbaih, Mohamed El-Shinawi
• Journal: African journal of emergency medicine : Revue africaine de la medecine d'urgence (Afr J Emerg Med) Vol. 13 Issue 2 Pg. 52-57 (Jun 2023) ISSN: 2211-4203 [Electronic] Netherlands
• PMID: 36937618 (Publication Type: Journal Article)
• Copyright: © 2023 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.