NEXUS C-Spine Criteria

Low-risk criteria to defer cervical spine imaging after blunt trauma
Blunt trauma with a possible cervical spine injury. All five criteria must be absent to defer imaging.
Posterior midline cervical tenderness
Focal neurological deficit
Altered level of alertness
Evidence of intoxication
Painful distracting injury
Evidence
Original publication
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma (NEXUS). Absence of all five criteria — midline tenderness, focal deficit, altered alertness, intoxication, distracting injury — had 99.6% sensitivity for clinically significant cervical spine injury.
New England Journal of Medicine, 2000
Open source
Validation
Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-Spine Rule versus the NEXUS low-risk criteria in patients with trauma. The Canadian C-Spine Rule outperformed NEXUS on sensitivity (99.4% vs 90.7%) in alert, stable patients.
New England Journal of Medicine, 2003
Open source
Last reviewed: 2026-09
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