NEXUS criteria

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.

See also

• Canadian c-spine rules

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.