The NEXUS study prospectively validated five clinical criteria to identify blunt trauma patients at low enough risk of cervical spine injury to safely forgo radiographic imaging. Conducted across 21 U.S. centers in 34,069 patients, it is the largest validation study of cervical spine clearance criteria to date. The central question: can bedside clinical assessment alone reliably rule out cervical spine injury?
Fear of missing occult cervical injury led physicians to image virtually every blunt trauma patient, generating roughly 800,000 cervical spine radiographs annually in the U.S. With the vast majority negative. The prior pilot study reported 100% sensitivity for these five criteria, but the confidence interval bottomed out at 89% — far too wide to justify widespread adoption.
NEXUS gives you a validated bedside rule: if a blunt trauma patient has no posterior midline tenderness, no neurologic deficit, normal alertness, no intoxication, and no distracting injury, imaging can be safely withheld. When even one criterion is failed, image the patient.
The criteria are intentionally non-prescriptive on what counts as 'distracting' or 'intoxicated'. The authors explicitly argue clinical judgment outperforms rigid definitions, and that over-defining the criteria would cause the tool to fall into disuse.
Apply these criteria, but remember they do not replace clinical judgment: the authors state physicians should feel free to image individual patients even when all five criteria are met if clinical concern is high.
The NEXUS study prospectively validated five clinical criteria to identify blunt trauma patients at low enough risk of cervical spine injury to safely forgo radiographic imaging. Conducted across 21 U.S. centers in 34,069 patients, it is the largest validation study of cervical spine clearance criteria to date. The central question: can bedside clinical assessment alone reliably rule out cervical spine injury?
Fear of missing occult cervical injury led physicians to image virtually every blunt trauma patient, generating roughly 800,000 cervical spine radiographs annually in the U.S. With the vast majority negative. The prior pilot study reported 100% sensitivity for these five criteria, but the confidence interval bottomed out at 89% — far too wide to justify widespread adoption.
NEXUS gives you a validated bedside rule: if a blunt trauma patient has no posterior midline tenderness, no neurologic deficit, normal alertness, no intoxication, and no distracting injury, imaging can be safely withheld. When even one criterion is failed, image the patient.
The criteria are intentionally non-prescriptive on what counts as 'distracting' or 'intoxicated'. The authors explicitly argue clinical judgment outperforms rigid definitions, and that over-defining the criteria would cause the tool to fall into disuse.
Apply these criteria, but remember they do not replace clinical judgment: the authors state physicians should feel free to image individual patients even when all five criteria are met if clinical concern is high.