Calculators · Emergency Medicine · Criteria
NEXUS criteria for cervical spine imaging
Also called NEXUS, NEXUS low-risk criteria, C-spine clearance
Five low-risk criteria that identify blunt trauma patients who do not need cervical spine imaging.
Imaging
Not required
All five low-risk criteria met. In 34,069 patients the rule had 99.0% sensitivity and 99.8% NPV for any cervical spine injury.
Formula and scoring
Low risk (no imaging) only if all five absent: midline tenderness, focal deficit, altered alertness, intoxication, distracting injury.
Exam and ward pearls
- Specificity is only 12.9%: NEXUS is a rule-out tool, not a predictor of injury.
When not to rely on it
- Validated in blunt trauma across US emergency departments; not for penetrating trauma.
Source
- Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. 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(2):94-9. doi:10.1056/NEJM200007133430203 · PMID 10891516
Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.