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Decision rules typically take the form of “you don't have to do X if the patient meets Y criteria.” This holds for the NEXUS chest rule, which requires absence of all seven of its criteria to forgo imaging, and has a 99.9% negative predictive value for excluding major thoracic injury. The downside is that such rules often have poor specificity, as exemplified by the rule's very low 13% specificity. Investigators analyzed this rule in a more nuanced way to provide criterion-specific rates of injury requiring medical intervention.
The study was a secondary analysis of two large observational studies that involved 21,382 patients with blunt trauma, of whom 4.6% had major clinical injuries. Among patients who failed the NEXUS rule due to the pre…