This is the first in a blog series that will explore landmark articles in Emergency Medicine.
- Patients meeting the following five simple clinical criteria are safe to clear without cervical spine imaging following blunt trauma:
- No focal neurologic deficit
- Normal alertness
- No intoxication
- No midline posterior bony cervical spine tenderness, and
- No painful distracting injury
- The sensitivity and specificity of the NEXUS criteria for detecting low probability injury and avoiding unnecessary imaging was 99 and 12.9 percent respectively, with a negative predictive value of 99.8 percent for the detection of clinically significant injuries.
Level of evidence: 1 (Prospective cohort trial)
Based on the ACEP grading scheme for diagnostic questions the NEXUS trial receives a class of evidence rating of 1.
Blunt trauma is a frequent cause of emergency department visits. However, the overall prevalence of cervical spine injury is generally only between 2-4% (2.4% in the NEXUS cohort). The goal of the NEXUS group was to create a simple clinical tool with which to risk stratify patients following blunt trauma, thereby reducing unnecessary cervical spine imaging and subsequently improving patient care through cost-reduction and a decrement in the downstream oncogenic risk secondary to radiation exposure. Continue reading