NEXUS criteria | Cervical Fracture Screening

In another post, we discussed the Canadian C-Spine rules used to rule out fractures of the cervical spine that would demand radiographic imagery. The Nexus criteria are another tool for the same purpose of reducing the need for radiographs after blunt trauma to the head. 

In a review by Michaleff et al. (2012), the reported sensitivity ranges from 83-100% and specificity from 2-46%.

If any of the following NEXUS criteria are present, imaging is recommended:

• Focal Neurologic Deficits (such as paralysis, paresthesia, speech vision and or hearing problems)
• Midline Spinal Tenderness
• Altered Level of Consciousness
• Intoxication
• Distracting Injury (another serious injury in a different body part that could distract from the neck injury)

An easy mnemonic to remember the rule is NSAID.

Another common screening tool for cervical fractures are the Canadian C-Spine Rules. If you want to screen for fractures in other body parts, check out the list below:

• Elbow Extension Test (Elbow)
• Caradeniz Wrist Rules (Wrist)
• Supine Sign (Thoracic Spine)
• Closed-Fist Percussion Test
• Patellar Pubic Percussion Test (Hip)
• Fulcrum Test (Femur)
• Ottawa Knee Rules (Knee)
• Ottawa Ankle Rules (Ankle & Foot)

Michaleff, Z. A., Maher, C. G., Verhagen, A. P., Rebbeck, T., & Lin, C. W. C. (2012). Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. Cmaj, 184(16), E867-E876.

Ghelichkhani, P., Shahsavarinia, K., Gharekhani, A., Taghizadieh, A., Baratloo, A., Fattah, F. H. R., … & Hosseini, M. (2021). Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule. La radiologia medica, 126(3), 414-420.