NEXUS Chest CT Rule

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Steve D. -

I don't think this rule adds anything. Why would I even consider a chest CT in an evaluable (i.e. not distracted) patient with no thoracic tenderness? That is just common sense to me. I don't think you need a rule to tell you that

Sean G., M.D. -

I agree with Steve D, some of these Decision Rules seem not very helpful;. This one in particular and the PECARN one.. They seem to be suggesting if there is no sign of injury, no complaint of injury a CT is not needed. Hopefully no EM trained docs need that sort of help. I think maybe a NP/PA perhaps may benefit, but EM docs even early in their career should know this. The Heart Score by contrast I believe is a very helpful instrument for a young practitioner. I find with significant clinical experience the Heart Score pretty much matches up with my gestalt, but for an attending early in their career I believe it may be quite helpful. I find some of this discussion very tedious. I find myself ever more disappointed with research and papers being produced in medicine in the states. We seem to have reams of not very helpful studies and many studies seem directed at pushing for an expensive drug or intervention(not this one of course)....I find research out of Europe and Asia and Australia to name a few seem more directed at pt well being. We should take a cue from them, unfortunately Medicine is big business here.

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