NEXUS C-Spine Rule
Check five NEXUS criteria to determine if cervical spine X-ray or CT can be safely skipped after blunt trauma.
NEXUS Low-Risk Criteria
Mark each criterion Present if the patient has that finding. All must be absent for low-risk classification.
1. Midline Cervical Tenderness
Tenderness to palpation along the posterior midline of the cervical spine from the nuchal ridge to the prominence of T1.
2. Focal Neurological Deficit
Any new focal neurological finding — motor weakness, sensory deficit, or reflex abnormality — attributed to cervical spine injury.
3. Altered Level of Alertness
GCS <15, agitation, combativeness, unresponsiveness, or inability to cooperate with the exam. Includes acute intoxication.
4. Intoxication
Evidence of alcohol or drug intoxication by history, clinical exam (odor, slurred speech, ataxia, behavior), or laboratory finding.
5. Distracting Injury
Any injury that may distract the patient from fully perceiving or reporting cervical spine pain — e.g., long-bone fractures, visceral injury, large burns.
Result
Select criteria on the left and click Evaluate.
| Criterion | Status |
|---|
Clinical decision support only. The NEXUS rule does not replace full clinical assessment and specialist judgment. Sensitivity 99.6%; some significant injuries may still be missed.
Quick Reference
Low risk (all absent): Imaging may be safely omitted. Sensitivity ~99.6% for significant injury.
Not low risk (any present): Cervical spine imaging is indicated. Consider X-ray series or CT depending on mechanism and clinical picture.
Summary
Check five NEXUS criteria to determine if cervical spine X-ray or CT can be safely skipped after blunt trauma.
How it works
- Assess the patient for each of the five NEXUS low-risk criteria.
- A criterion is "present" (positive) if the patient has that finding; "absent" (negative) if they do not.
- If ALL five criteria are absent, the patient meets low-risk criteria and imaging may be safely omitted.
- If ANY one criterion is present, the patient does NOT meet low-risk criteria and cervical spine imaging is indicated.
- The tool displays an immediate recommendation with a per-criterion breakdown.
Use cases
- Triage blunt-trauma patients in the emergency department for c-spine imaging.
- Determine whether a cervical collar can be safely removed without imaging.
- Teach medical students and residents about evidence-based c-spine clearance.
- Document clinical reasoning for or against cervical spine imaging.
- Support paramedic and nursing pre-screening in trauma settings.