NEXUS C-Spine Criteria
Identifies patients who can have cervical spine cleared without radiography
How to use & interpret
The NEXUS criteria help decide whether cervical-spine imaging can be safely omitted after blunt trauma. The neck can be cleared clinically only if ALL five low-risk criteria are met: no posterior midline cervical tenderness, no focal neurological deficit, normal alertness, no intoxication, and no painful distracting injury.
If any criterion is not met, imaging is required. NEXUS is highly sensitive; the Canadian C-spine rule is an alternative that can be more specific in alert, stable patients.
Score interpretation
All 5 criteria absent — C-spine injury effectively excluded
→ No radiography required. Sensitivity 99.6%, specificity 12.9%.
One or more criteria present — cannot clinically clear C-spine
→ Cervical spine immobilisation; CT C-spine (preferred over plain films)
Interpretation bands for the NEXUS. Apply clinical judgement and local guidance.
Frequently asked questions
NEXUS or the Canadian C-spine rule?
Both are validated. The Canadian C-spine rule tends to be more specific (fewer images) in alert, stable adults, while NEXUS is simpler. Follow your local trauma pathway and applicability criteria.
References
- Hoffman JR, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. NEJM. 2000;343(2):94–9.
Related
Curated clinical cross-links plus same-class fallbacks.
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The NEXUS is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.