NEXUS Cervical Spine Criteria

NEXUS (Hoffman 2000)

Identifies blunt-trauma patients who can forgo cervical spine imaging. Imaging is considered unnecessary only when all five low-risk criteria are absent: no midline tenderness, no focal deficit, normal alertness, no intoxication, and no distracting injury.

Also searched as: trauma · clearance · decision rule · emergency · c-spine

Posterior midline cervical spine tenderness

Tenderness on palpation of the posterior midline neck from the nuchal ridge to the first thoracic prominence, or pain on direct palpation of any cervical spinous process.

Focal neurologic deficit

Any focal motor or sensory deficit attributable to the cervical spine.

Altered level of alertness

Evidence of altered consciousness: GCS 14 or less, disorientation, delayed or inappropriate responses, or inability to remember 3 of 3 objects at 5 minutes.

Evidence of intoxication

Recent history of alcohol or drug ingestion, or examination/odor/slurred speech/ataxia findings, or a positive test.

Painful distracting injury

Any injury severe enough to distract from cervical spine pain, e.g. long-bone fracture, visceral injury, large laceration or burn, crush or degloving injury.

Information

Incomplete input

Answer all five criteria (present or absent). Cervical spine imaging can only be withheld when every criterion is explicitly absent.

How this tool works

The NEXUS low-risk criteria were validated in a prospective study of 34,069 blunt-trauma patients. When all five criteria are absent, the probability of a clinically significant cervical spine injury is extremely low, and plain imaging can be withheld. If any single criterion is present, the patient does not meet low-risk standards and cervical spine imaging is indicated. The criteria are widely applied in alert, stable adults; caution and judgment are still needed in the elderly, in children, and in patients whose examination is unreliable.

References

Hoffman JR et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000;343:94-9.

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

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