Prevalence of Chest Injury With the Presence of NEXUS Chest Criteria: Data to Inform Shared Decisionmaking About Imaging Use
Prevalence of Chest Injury With the Presence of NEXUS Chest Criteria: Data to Inform Shared Decisionmaking About Imaging Use
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DOI：
10.1016/j.annemergmed.2015.09.024
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发表时间：
2016-08-01
影响因子：
6.2
通讯作者：
Rodriguez, Robert M.
中科院分区：
文献类型：
--
作者：
Raja, Ali S.;Lanning, Jennifer;Rodriguez, Robert M.
研究目的：NEXUS胸部决策工具识别出了一个非常低风险的钝性创伤患者人群，可以避免胸部成像。然而，它要求所有7个国家紧急X射线利用研究（NEXUS）胸部标准都不存在。为了告知患者和医生关于成像的共同决策，我们描述了NEXUS胸部决策仪器的各个标准的测试特征，并提供了7个标准中的1个、2个或3个标准存在时的损伤患病率。我们对2个前瞻性收集的年龄大于14岁并参加NEXUS胸部研究的钝性创伤患者队列进行了二次分析2009年12月至2012年1月。9个美国I级创伤中心的医生记录了是否存在7个NEXUS胸部标准。我们计算了每个标准的测试特性和组合标准的主要临床损伤和胸部损伤的胸部imaging observed on chest imaging.Results的结果措施：我们招募了21，382例患者，其中992（4.6%）有重大临床损伤和3，135（14.7%）有胸部损伤的胸部影像学观察。个体测试特征的灵敏度范围为15%至56%的重大临床损伤和14%至53%的胸部成像上观察到的胸部损伤，与特异性范围为71%至84%的重大临床损伤和67%至84%的胸部成像上观察到的胸部损伤。单个NEXUS标准的严重临床损伤发生率为1.9%~ 3.8%，胸部影像学检查发现的胸部损伤发生率为5.3%~ 11.5%。根据标准的组合，具有2或3个因素的患者发生重大临床损伤的风险范围为1.7%至16.6%。标准特定风险可用于告知患者及其医生关于成像需求的共同决策。
Study objective: The NEXUS chest decision instrument identifies a very-low-risk population of patients with blunt trauma for whom chest imaging can be avoided. However, it requires that all 7 National Emergency X-Ray Utilization Study (NEXUS) chest criteria be absent. To inform patient and physician shared decisionmaking about imaging, we describe the test characteristics of individual criteria of the NEXUS chest decision instrument and provide the prevalence of injuries when 1, 2, or 3 of the 7 criteria are present.Methods: We conducted this secondary analysis of 2 prospectively collected cohorts of patients with blunt trauma who were older than 14 years and enrolled in NEXUS chest studies between December 2009 and January 2012. Physicians at 9 US Level I trauma centers recorded the presence or absence of the 7 NEXUS chest criteria. We calculated test characteristics of each criterion and combinations of criteria for the outcome measures of major clinical injuries and thoracic injury observed on chest imaging.Results: We enrolled 21,382 patients, of whom 992(4.6%) had major clinical injuries and 3,135(14.7%) had thoracic injuries observed on chest imaging. Sensitivities of individual test characteristics ranged from 15% to 56% for major clinical injury and 14% to 53% for thoracic injury observed on chest imaging, with specificities varying from 71% to 84% for major clinical injury and 67% to 84% for thoracic injury observed on chest imaging. Individual criteria were associated with a prevalence of major clinical injury between 1.9% and 3.8% and of thoracic injury observed on chest imaging between 5.3% and 11.5%.Conclusion: Patients with isolated NEXUS chest criteria have low rates of major clinical injury. The risk of major clinical injury for patients with 2 or 3 factors range from 1.7% to 16.6%, depending on the combination of criteria. Criteria specific risks could be used to inform shared decisionmaking about the need for imaging by patients and their physicians.