NEXUS criteria

Last revised by Arlene Campos on 12 Jan 2024

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.

A commonly used mnemonic to remember the criteria is "NSAID":

  • neurological deficit

  • spinal tenderness

  • altered mental status

  • intoxication

  • distracting injury

See also

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.

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