NEXUS cervical spine rule

Background

• 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

Workup

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

Mnemonic - NSAID:

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

See Also

• Blunt neck trauma
• C-Spine X-Ray
• Cervical spine clearance
• Canadian cervical spine rule
• EBQ:Canadian C-spine Rule Study
• EBQ:NEXUS

External Links

• MDCalc Canadian C-Spine Rule
• MDCalc NEXUS

References

Authors

Jordan Swartz, Ross Donaldson, Mark Russell, Neil Young, Kevin Lu, Michael Holtz, Daniel Ostermayer, Ann Huang, Kurt Hansen, Christopher Kim