Nexus C-Spine Xray Criteria
Info
No tenderness at the posterior midline of the cervical spine True False
No focal neurologic deficit True False
Normal level of alertness True False
No evidence of intoxication True False
No clinically apparent painful distracting injury True False
R e s u l t s
---
 
Result
 
Show Results
Info
Nexus C-Spine Xray Criteria

Cervical radiography following blunt trauma is extremely common.  However, eliminating unnecessary radiographs by clinical criteria is recommended in appropriate cases.

 

The National Emergency X-Radiography Utilization Study (NEXUS) was a major study used to validate this set of criteria and tested prospectively that patients who meet all 5 criteria listed below have very low probability of "clinically significant injury to the cervical spine."

 

The study by Hoffman et al., involved 21 centers, with 34,069 patients who received C-spine radiography following blunt trauma.  These criteria identified all but 8 of the 818 patients who had cervical spine injury.  Sensitivity was 99.0% and negative predictive value of 99.8%.

 

The 5 criteria

  • No tenderness at the posterior midline of the cervical spine
  • No focal neurologic deficit
  • Normal level of alertness
  • No evidence of intoxication
  • No clinically apparent painful distracting injury

 

Reference:

Hoffman JR, et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461-9.

Hoffman, JR, et al. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. NEJM. 2000 July 13;343:94-9.

Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;12:1454-60.