NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging.
Trauma patients who do not require cervical spine imaging require all of the following:
- alert and stable
- no focal neurologic deficit
- no altered level of consciousness
- not intoxicated
- no midline spinal tenderness
- no distracting injury
The NEXUS criteria have a sensitivity of 99.6% for ruling out cervical spine injury in the original study validating the criteria (95% confidence interval, 98.6-100%) 2.
The NEXUS criteria may not be reliable with patient >65 years of age, however 4.
There is some debate over whether the NEXUS criteria or the Canadian C-spine rules (CCR) are more reliable for excluding C-spine injury, though high-quality evidence points to better sensibility, better sensitivity, and a lower rate of imaging use when following the CCR criteria 3.
- 1. Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Annals of emergency medicine. 32 (4): 461-9. Pubmed
- 2. 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. The New England journal of medicine. 343 (2): 94-9. doi:10.1056/NEJM200007133430203 - Pubmed
- 3. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. The New England journal of medicine. 349 (26): 2510-8. doi:10.1056/NEJMoa031375 - Pubmed
- 4. Paykin G, O'Reilly G, Ackland HM, Mitra B. The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. Injury. 48 (5): 1020-1024. doi:10.1016/j.injury.2017.02.013 - Pubmed