How it's calculated
Cervical spine imaging can be safely withheld only if all five low-risk criteria are absent — presence of any one criterion indicates a need for imaging.
Criteria
| Criterion |
|---|
| Midline cervical spine tenderness |
| Focal neurological deficit |
| Altered level of consciousness |
| Evidence of intoxication |
| Presence of a distracting painful injury |
Clinical use
- Applies to alert, stable trauma patients being considered for cervical spine clearance without imaging.
- The Canadian C-Spine Rule is an alternative decision instrument, generally considered to have somewhat higher sensitivity in some validation studies — either tool may be used per local protocol.
- Not intended for use in patients with penetrating trauma, known vertebral disease, or in children under the validated age range.
- A 'positive' result (any criterion present) means imaging is indicated, not that a cervical spine injury is present — imaging is a diagnostic step, not a diagnosis.
Frequently asked questions
What is the NEXUS Criteria used for?
It helps decide whether cervical spine imaging is needed after blunt trauma, allowing imaging to be safely withheld in appropriately selected low-risk patients.
What happens if all five criteria are absent?
Cervical spine imaging can generally be safely withheld — the rule has high sensitivity for excluding clinically significant injury when fully negative.
How does this differ from the Canadian C-Spine Rule?
Both are validated clinical decision rules for the same purpose; the Canadian C-Spine Rule uses additional criteria and a slightly different structure, and some studies suggest higher sensitivity, but either is acceptable per local protocol.
Does a positive NEXUS result mean there is a spine injury?
No — it means imaging is indicated to look for one, not that an injury has been confirmed.
References
- Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-99.
- Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848.