NEXUS cervical spine rule

Background

• Inclusion criteria is blunt trauma to the cervical spine
• 99.6% sensitive for a clinically important injury (only 12.9% Sp)
• Only 8.6% of patients were elderly in the initial study; use caution in applying to elderly
  • Nexus does not risk stratify based on age like CCR
  • Small studies show elderly pts with c-spine fractures do not often have midline tenderness

Rule

Radiography is Unnecessary if pts satisfy ALL of the following low risk criteria:

1. No midline cervical tenderness
2. No focal neuro deficits
3. Normal alertness
4. No intoxication
5. No painful distracting injury

Mneumonic - NSAID:

1. Neuro deficit
2. Spinal midline tenderness in C-spine
3. Alertness
4. Intoxication
5. Distracting injury

See Also

• Blunt neck trauma
• C-Spine X-Ray
• C-Spine (Canadian Rule)

Source

Cervical Spine Injury, EB Medicine April, 2009