NEXUS Criteria for Cervical Spine Clearance After Trauma
The NEXUS (National Emergency X-Radiography Utilization Study) criteria are a validated clinical decision rule for identifying patients who require cervical spine imaging after blunt trauma. When all 5 criteria are negative, imaging can be safely avoided with 99.6% sensitivity.
About
The NEXUS criteria were developed through a prospective multicenter study of over 34,000 patients (NEJM 2000). All five criteria must be negative to clear the C-spine: no posterior midline tenderness, no intoxication, normal alertness, no focal neurologic deficit, no painful distracting injury.
Formula
C-spine cleared if ALL 5 are absent
The NEXUS rule requires all five conditions for safe C-spine clearance: no posterior midline tenderness on palpation, no intoxication (clinical or lab), GCS 15 with normal alertness, no focal motor/sensory/reflex deficit, and no distracting painful injury (fracture, visceral injury, large laceration). Any positive criterion requires imaging.
Score Interpretation
NEXUS is one of the most validated clinical decision rules in emergency medicine, with 99.6% sensitivity for clinically significant C-spine injuries and 99.9% negative predictive value across 34,000+ patients.
C-Spine Cleared — 0–0
All 5 NEXUS criteria negative. C-spine can be clinically cleared without imaging.
Management: Document negative criteria. Remove C-spine precautions. No imaging required.
Imaging Indicated — 1–5
One or more NEXUS criteria positive. C-spine imaging indicated.
Management: Obtain CT cervical spine. Maintain C-spine precautions until injury excluded.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Blunt trauma patients | 0/5 cleared, 1-5/5 imaging | Sensitivity 99.6% for significant injury |
Dr. Khaled Hassan
Dr. Khaled is a consultant in emergency medicine with trauma experience.
View medical review board & editorial policy →Example Calculation
32-year-old MVC, GCS 15, no midline tenderness, no intoxication, normal alertness, no neuro deficit, no distracting injuries. All 5 negative - C-spine cleared.
Related Conditions
Common Mistakes
Applying NEXUS to penetrating trauma
NEXUS validated only for blunt trauma.
Clearing C-spine when intoxicated
Intoxication alone is a positive criterion.
Frequently Asked Questions
What is NEXUS sensitivity?
NEXUS vs Canadian C-Spine Rule?
References
Related Calculators
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