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NEXUS Criteria for C-Spine Imaging

After blunt trauma, cervical spine imaging is not required if all five NEXUS low-risk criteria are met: no posterior midline tenderness, no intoxication, normal alertness, no focal neurological deficit and no painful distracting injury. Sensitivity 99.6% in the validation cohort.

Posterior midline cervical tenderness (yes/no, +1)
Evidence of intoxication (yes/no, +1)
Altered alertness (yes/no, +1)
Focal neurological deficit (yes/no, +1)
Painful distracting injury (yes/no, +1)

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Interpretation

Result	Meaning
All 5 low-risk criteria met	No imaging required
Any criterion not met	Imaging recommended

Formula

No imaging if ALL: no posterior midline tenderness · no intoxication · normal alertness · no focal neuro deficit · no painful distracting injury.

Clinical pearls

Population: blunt trauma patients of all ages in 21 US EDs who underwent cervical spine imaging; very few young children were enrolled, so use caution under age 9.
Validation sensitivity 99.0% for any injury and 99.6% for clinically significant injury; specificity only 12.9%.
Elderly patients: several studies report lower sensitivity in patients ≥65; many clinicians prefer the Canadian C-Spine Rule in alert, stable adults.

Examples

nexus: no midline tenderness, sober, alert, no focal deficits, no distracting injury does a drunk patient after a car crash need c spine imaging per nexus

FAQ

What counts as a distracting injury?

Any painful injury that might impair the patient's ability to appreciate neck pain, such as a long-bone fracture, large laceration, crush injury or major burn.

Does NEXUS apply to penetrating trauma?

No, it was validated only in blunt trauma.

Evidence

Hoffman JR et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000;343:94–9.

Emergency & Trauma · Reviewed 2026-10-14 · Methodology