NEXUS C-Spine Xray Criteria
Info
No tenderness at the posterior midline of the cervical spine Yes No
No focal neurologic deficit Yes No
Normal level of alertness Yes No
No evidence of intoxication Yes No
No clinically apparent painful distracting injury Yes No
R e s u l t s
---
 
Output
 
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:

  1. Hoffman JR, Wolfson AB, Todd K, 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.
  2. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. NEJM . 2000;343:94-9.
  3. Hoffman JR, Schriger DL, Mower W, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;12:1454-60.