NEXUS cervical spine rule


  • Inclusion criteria is blunt neck trauma
  • 99.6% sensitive for a clinically important injury (only 12.9% Sp)
  • Only 8.6% of patients were elderly in the initial study; use caution in applying to elderly
    • Nexus does not risk stratify based on age like CCR
    • Small studies show elderly patients with c-spine fractures do not often have midline tenderness


NEXUS Cervical Spine Rule

Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:

  • No midline cervical tenderness
  • No focal neuro deficits
  • Normal alertness
  • No intoxication
  • No painful distracting injury

C-spine imaging should be considered unless the patient meets all of the above low risk criteria[1] [2]

Mnemonic - NSAID:

  1. Neuro deficit
  2. Spinal midline tenderness in C-spine
  3. Alertness
  4. Intoxication
  5. Distracting injury

See Also

External Links


  1. 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60.
  2. Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201