Emergency Medicine Decision rule Strong evidence Clinical review pending v1.0.0

NEXUS Criteria for C-Spine Imaging

Can cervical spine imaging be safely avoided after blunt trauma?

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About this tool

Five low-risk criteria; if all are absent, cervical spine imaging is not indicated.

Intended use

Patients with blunt trauma and possible cervical spine injury.

Outcome

Clinically significant cervical spine injury

Time horizon

Index visit

Derivation population

21 US emergency departments.

Limitations

'Distracting injury' and 'intoxication' are subjective.
Lower sensitivity reported in older adults.

Clinical problems

Head and neck trauma

Evidence

Evidence level

Strong evidence

Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology

Validation studies

NEXUS prospective validation (Hoffman 2000)

34,069 patientsProspective

Sensitivity 99.6%, specificity 12.9%, NPV 99.9% for clinically significant injury.

Evidence summaries for this tool are awaiting independent clinical review. Statistics are shown only where they could be attributed to a specific publication.

References

Original publicationHoffman 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;343:94-99. Find on PubMed (opens in a new tab)

Version history

Version	Formula	Effective	Reviewer	Changes
v1.0.0	Hoffman 2000	2026-10-03	—	Initial implementation with reference test vectors.

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Clinical decision support only. Interpret results in the context of the individual patient and current guidance; HumanPulse does not replace professional medical judgment.