Trauma & Burns

NEXUS Cervical Spine Criteria (NEXUS) Calculator

Five findings that, when all absent after blunt trauma, identify patients who do not need cervical spine imaging.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Formula

Imaging is not needed only if all five are absent:
Posterior midline cervical tenderness
Evidence of intoxication
Altered alertness
Focal neurologic deficit
Painful distracting injury

How it is used

• In 34,069 blunt-trauma patients at 21 US centers who had cervical imaging, the criteria identified 810 of 818 injuries (sensitivity 99.0%, negative predictive value 99.8%) with a specificity of 12.9% (Hoffman 2000).
• Applying it would have avoided imaging in 4,309 patients (12.6%) (Hoffman 2000).
• It is an imaging decision rule for the emergency department, not a field rule for spinal motion restriction.

Key points

• Any one positive finding means the spine is not cleared clinically: keep the collar on and image.

Same formula as the app. Open it in the web app.

Related one-pagers

• Spinal Motion RestrictionNEXUS · Blunt trauma · All 5: alert, sober, no midline tenderness, deficit or painful distracting injury
• Burns
• Trauma: Primary and Secondary Survey

Related calculators

• Burn Fluids (ABA Consensus 2 mL/kg)
• Burn Size (Rule of Nines)
• Canadian CT Head Rule (CCHR)
• Ottawa Ankle and Foot Rules
• Ottawa Knee Rule

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.