NEXUS criteria (cervical spine)
Clinical clearance of the cervical spine without imaging after blunt trauma
Sources last checked: 2026-10-13
NEXUS criteria (cervical spine)
Clinical clearance of the cervical spine without imaging after blunt trauma
Tick a criterion only when it is positively confirmed — an unchecked box counts as 'not met' and gives the result 'imaging indicated'. Specificity is low (12.9 %); in alert, stable adults the Canadian C-Spine Rule is more specific. Experience in older adults and young children is limited.
Interpretation
| Rule not applicable | The patient is outside the population the rule was derived in, so the rule makes no statement about imaging for this patient. |
|---|---|
| Low probability — imaging not required by the criteria | All five criteria met. In the validation cohort of 34,069 patients, sensitivity was 99.0 % and negative predictive value 99.8 %. |
| Imaging indicated by the criteria | At least one criterion is not met, so the cervical spine cannot be cleared clinically. |
What is the NEXUS criteria (cervical spine)?
The NEXUS criteria identify blunt-trauma patients with a very low probability of cervical-spine injury who do not need imaging. Hoffman and colleagues validated them in 2000 in 34,069 patients at 21 US centres (National Emergency X-Radiography Utilization Study). All five criteria must be met to forgo imaging.
When to use it
- Blunt trauma patients in whom cervical-spine imaging is being considered.
- Rapid clinical clearance in the emergency department, including when the Canadian rule's exclusions apply.
- Teaching structured spinal clearance.
When not to use it
- Penetrating neck trauma.
- Patients who cannot be examined reliably for any of the five criteria.
How it is calculated
Imaging is not required only if ALL five are met: no posterior midline cervical tenderness, no evidence of intoxication, normal alertness, no focal neurological deficit, no painful distracting injury. Any criterion not met → imaging.
Clinical pearls and limitations
- Tick a criterion only when it is positively confirmed — an unchecked box counts as 'not met' and gives the result 'imaging indicated'. Specificity is low (12.9 %); in alert, stable adults the Canadian C-Spine Rule is more specific. Experience in older adults and young children is limited.
- Whether an injury is 'distracting' is a clinical judgement — typically a painful injury such as a long-bone fracture.
- Specificity is only about 13 % — many patients still need imaging.
- Sensitivity was 99 % for any injury and 99.6 % for clinically significant injury.
- In this calculator, unticked criteria count as not met, so the default result is 'imaging'.
Frequently asked questions
What are the five NEXUS criteria?
No posterior midline cervical tenderness, no evidence of intoxication, normal alertness, no focal neurological deficit, no painful distracting injury.
Can NEXUS be used in older patients?
It has been applied, but experience is limited and performance may be lower; many pathways image older adults with a low threshold.
What counts as intoxication?
History or clinical evidence of alcohol or drug intoxication that may impair pain perception or examination.
Evidence and guidelines
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<p><a href="https://medelix.ai/en/calculators/nexus-criteria">NEXUS criteria (cervical spine) calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.