NEXUS C-Spine Criteria

Determine whether cervical spine imaging can be safely avoided


For use in blunt trauma patients. Validated in a large multi-centered trial that included over 34,000 patients. Sensitivity was reported at 99.6% with a specificity of 12.9%. The rule was validated in all age ranges over 1 year, however the small numbers in the study suggest caution may be required in children under 18 years.

A comparison study between the NEXUS Criteria and the Canadian C-Spine Rule suggested that the NEXUS criteria are less sensitive (90.7 vs. 95-99%), though there remains some controversy over the results and methodology.


Stiell et al.

New England Journal of Medicine 2003 December 25, 349 (26): 2510-8

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1. Midline Neck Tenderness?

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Midline posterior bony cervical spine tenderness is present if the patient complains of pain on palpation of the posterior midline neck from the nuchal ridge to the prominence of the first thoracic vertebra, or if the patient evinces pain with direct palpation of any cervical spinous process.

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