For healthcare professionals
NEXUS C-Spine Criteria
The NEXUS low-risk criteria help decide which patients with blunt trauma need imaging of the cervical spine (neck). A patient who meets all five criteria is low risk. Hoffman and colleagues validated them in 2000. This tool is written for clinicians and is not a diagnosis.
Patient findings
Tick each finding that is present. Nothing you enter leaves this page.
What you will see
Whether the patient is low risk by the criteria, or which findings call for imaging.
Educational only, not medical advice. Not a diagnosis. Imaging decisions belong to the treating team.
Source
Hoffman JR and colleagues, New England Journal of Medicine 2000 (the National Emergency X-Radiography Utilization Study, NEXUS). The criteria are taken from the open-access (CC BY) introduction of Ajah and Nzekwu, Cureus 2025, and match the description in Ekhator and colleagues, Cureus 2022 (CC BY). The tests check each of the five findings and that the criteria only apply after blunt trauma.
Validated in
Patients with blunt trauma. The criteria were developed in a study of 34,069 patients, of whom only 2.5% were aged 8 years or younger (Ekhator 2022).
Limits
The criteria are built to rule out injury, not to find it: a finding means imaging is indicated, not that the spine is injured. Concerns have been raised about their sensitivity in older adults and children, and a systematic review found weak support for using them in children (Ekhator 2022).
The criteria
A patient with blunt trauma is low risk, and cervical spine imaging is not indicated by the criteria, if all five of the following are true (Ajah 2025):
- No posterior midline cervical spine tenderness
- No evidence of intoxication
- A normal level of consciousness
- No focal neurologic deficit
- No painful distracting injury
Imaging is indicated if any one of the five is not met (Ekhator 2022). The criteria were validated by Hoffman and colleagues (Hoffman 2000).
Worked example: an alert, sober adult after a low-speed car crash who has no neck tenderness in the midline, no neurologic deficit and no other painful injury meets all five criteria, so the criteria do not call for imaging. If the same patient had been drinking, the criteria would call for imaging.
What the studies found
In the original study, the criteria had a sensitivity of 99.6% (95% confidence interval 98.6% to 100%) for cervical spine injury (Ekhator 2022).
A systematic review of the criteria in children concluded that support for using them in children is weak, citing low sensitivity, reliability and acceptance in some studies (Ekhator 2022).
Related calculators
For alert, stable adults, see also the Canadian C-Spine Rule. For head injury, see the Canadian CT Head Rule and the Glasgow Coma Scale calculator. For limb injuries, see the Ottawa Ankle Rules and the Ottawa Knee Rule. Other bedside scores are listed under For healthcare professionals.
Sources
- Ajah HE, Nzekwu OO. Development of a Hybrid Cervical Spine Clearance Algorithm in Trauma: Tackling the Challenges of the NEXUS Criteria and Canadian C-Spine Rule. Cureus. 2025;17(11):e96748. doi:10.7759/cureus.96748. PMID 41393582. Open access (CC BY 4.0). Introduction: the five NEXUS criteria. pmc.ncbi.nlm.nih.gov/articles/PMC12701536/
- Ekhator C, Nwankwo I, Nicol A. Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review. Cureus. 2022;14(10):e30065. doi:10.7759/cureus.30065. PMID 36238421. Open access (CC BY 3.0). Imaging indicated if any criterion is met; original sensitivity 99.6%; 34,069 patients, 2.5% aged 8 or younger; weak support in children. pmc.ncbi.nlm.nih.gov/articles/PMC9547612/
- Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-99. PMID 10891516. Original paper (cited; the criteria used here are taken from Ajah 2025, CC BY). pubmed.ncbi.nlm.nih.gov/10891516/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.