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NEXUS C-Spine
Rule out cervical spine injury without imaging in blunt trauma
Indication
- Rule out cervical spine injury without imaging in blunt trauma
Criteria
- id: midline; label: Posterior midline cervical tenderness; type: yesno; points: 1
- id: focal; label: Focal neurologic deficit; type: yesno; points: 1
- id: alertness; label: Altered level of alertness; type: yesno; points: 1
- id: intox; label: Evidence of intoxication; type: yesno; points: 1
- id: distracting; label: Distracting injury; type: yesno; points: 1
Interpretation
- function(score) { if (score === 0) return { risk: '0/5', tier: 'Low Risk', action: 'All 5 criteria negative. C-spine imaging NOT indicated. 99.6% sensitivity.', color: 'green' }; return { risk: score + '/5 criteria positive', tier: 'Cannot Clear', action: 'One or more criteria positive. C-spine imaging required.', color: 'red' }; }
Clinical pearls
- ALL 5 criteria must be negative to clear c-spine clinically
- 99.6% sensitivity for clinically significant c-spine injury
- Alternative: Canadian C-Spine Rule (slightly higher sensitivity)
- "Distracting injury" is subjective — use clinical judgment
Source and review
- Hoffman et al., NEJM 2000 (NEXUS). Last reviewed: 2024-10-15