- NEXUS Criteria support NOT obtaining a Cervical Spine series in mild to moderate Blunt Neck Trauma IF all criteria are negative
- Age under 2 years old (and use only with caution for children under age 8 years)
- High risk injuries
- Direct blows to neck or Penetrating Neck Trauma
- Comorbid conditions with higher risk of C-Spine Injury
- Severe Osteoporosis
- Advanced Arthritis or degenerative bone disease
- Cancer
- Based on study of over 34,000 patients across 21 Trauma Centers
- Five criteria identified almost 100% of Cervical Spine injuries (818 or 2.4% Incidence of C-Spine injuries)
- Test Sensitivity: 99.6%
- Test Specificity: 12.9%
- Negative Predictive Value: 99.9%
- NEXUS
- No posterior midline cervical tenderness
- No Alcohol Intoxication
- No focal neurologic deficit
- No distracting injury
- Long bone extremity Fracture
- Visceral injury requiring surgical Consultation
- Large Laceration
- Degloving injury
- Crush Injury
- Large burns
- Facial Fractures
- Acute functional Impairment (e.g. Intracranial Hemorrhage)
- Thoracic Injury (especially upper torso)
- Normal level of alertness
- Glasgow Coma Scale (GCS) 15 and/or
- No Disorientation and/or
- Able to remember 3 objects after minutes and/or
- Appropriate response to stimuli
- No Cervical Spine imaging needed if all 5 NEXUS Criteria met
- Distracting injury
- Thoracic Injury is a significant distracting injury and indicates Cervical Spine imaging
- Awake and alert patient with a normal neck and Neurologic Exam and a non-thoracic distracting injury
- May be reasonable to clear without imaging despite non-Thoracic Injury
- Rose (2012) J Trauma Acute Care Surg 73(2):498-502 [PubMed]