Orthopedics Book



NEXUS Cervical Spine Decision Rule

Aka: NEXUS Cervical Spine Decision Rule, NEXUS Criteria
  1. See Also
    1. Cervical Spine Imaging in Acute Traumatic Injury
    2. Canadian Cervical Spine Rule
    3. Cervical Spine CT
  2. Indications
    1. Cervical Spine Imaging in Acute Traumatic Injury
  3. Definition
    1. NEXUS Criteria support NOT obtaining a Cervical Spine series in mild to moderate Blunt Neck Trauma IF all criteria are negative
  4. Indications
    1. Blunt Neck Trauma
  5. Contraindications (cases in which not to rely on NEXUS rules to exclude need for Cervical Spine imaging)
    1. Age under 2 years old (and use only with caution for children under age 8 years)
    2. High risk injuries
    3. Direct blows to neck or Penetrating Neck Trauma
    4. Comorbid conditions with higher risk of C-Spine Injury
      1. Severe Osteoporosis
      2. Advanced Arthritis or degenerative bone disease
      3. Cancer
  6. Efficacy
    1. Based on study of over 34,000 patients across 21 Trauma Centers
    2. Five criteria identified almost 100% of Cervical Spine injuries (818 or 2.4% Incidence of C-Spine injuries)
    3. Test Sensitivity: 99.6%
    4. Test Specificity: 12.9%
    5. Negative Predictive Value: 99.9%
  7. Criteria: NEXUS
    1. No posterior midline cervical tenderness
    2. No Alcohol Intoxication
    3. No focal neurologic deficit
    4. No distracting injury
      1. Long bone extremity Fracture
      2. Visceral injury requiring surgical Consultation
      3. Large Laceration
      4. Degloving injury
      5. Crush Injury
      6. Large burns
      7. Facial Fractures
      8. Acute functional Impairment (e.g. Intracranial Hemorrhage)
      9. Thoracic Injury (especially upper torso)
    5. Normal level of alertness
      1. Glasgow Coma Scale (GCS) 15 and/or
      2. No Disorientation and/or
      3. Able to remember 3 objects after minutes and/or
      4. Appropriate response to stimuli
  8. Interpretation
    1. No Cervical Spine imaging needed if all 5 NEXUS Criteria met
    2. Distracting injury
      1. Thoracic Injury is a significant distracting injury and indicates Cervical Spine imaging
        1. Hefferman (2005) J Trauma 59(6): 1396-9 [PubMed]
        2. Konstantinidis (2011) J Trauma 71(3): 528-32 [PubMed]
      2. Awake and alert patient with a normal neck and Neurologic Exam and a non-thoracic distracting injury
        1. May be reasonable to clear without imaging despite non-Thoracic Injury
        2. Rose (2012) J Trauma Acute Care Surg 73(2):498-502 [PubMed]
  9. References
    1. Hoffman (2000) N Engl J Med 343: 94-9 [PubMed]

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