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NEXUS C-Spine Decision Instrument

The NEXUS C-spine decision instrument is extremely sensitive for determining which patients should have imaging performed after neck trauma. It’s important to note that this decision tool is a 1-way instrument – it tells you who should not be imaged but positive criteria doesn’t mean you HAVE to image the patient since specificity is very low. Appropriate application of this instrument would significantly reduce c-spine imaging in the ED but improper application could paradoxically increase imaging. The authors additionally note that no decision instrument is perfect and that NEXUS would have missed cervical injuries in 1 in 4000 patients to whom it was applied. Based on the number of blunt…

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  NEXUS Criteria for C-Spine Imaging

The notion that tenderness is quantifiable on a score without trusting the patient is crazy. Let’s go back and remember what this is about: our goal was never to get rid of negative c-spine films, our goal was to get rid of an extra percentage of those. 98% of them were already negative. We wanted to see if there was a way to avoid doing a film in somebody that everyone in the world knows is okay, and we’re only doing it because we’re all scared.

Articles of Interest

NEXUS Criteria for C-Spine Imaging

The NEXUS criteria for C-spine imaging clear patients from cervical spine fracture clinically, without imaging. Unlike the Canadian C-spine rule (CCR), the NEXUS criteria do not have age cutoffs and are theoretically applicable to all patients aged > 1 year.

NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis

Our study demonstrates that both NEXUS and CCR can be used in ruling out patients with low risk of CSI, and CCR was shown to have superior performance. Even though these tools have low specificity, their application can still greatly reduce the number of radiographic imaging performed in emergency departments.

Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

Our study validates the use of a modified NEXUS criteria in a low-risk elderly fall population. Using “variation from baseline mental status” and “evidence of injury to the face or head” as a substitute of distracting injury resulted in a sensitivity and negative predictive value of 100%.

The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients

Compared with the general adult blunt trauma population, the NEXUS criteria are less sensitive in excluding cervical spine fractures in older blunt trauma patients. We therefore suggest that liberal imaging be considered for older patients regardless of history or examination findings and that the addition of an age criterion to the NEXUS criteria be investigated in future studies.

The NEXUS criteria do they stand the test of time?

The NEXUS criteria are frequently used, as the Canadian cervical spine rules have been noted to be difficult to learn, remember and implement... Despite previous validation studies of the NEXUS criteria in the elderly population, we would urge caution in using the NEXUS criteria alone in determining radiography of the C-spine in the elderly.

Why We Use NEXUS for C-Spine Clearance

The NEXUS criteria can be used to determine which patients do not need c-spine x-rays. Since this was published, we have shifted to predominantly CT imaging, which is more sensitive. Also, we have learned that NEXUS is not as sensitive in elderly patients.

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Physiopedia

However, the original research only included a limited number of paediatric subjects, leading to a questionable applicability of the tool on children[4]. Subsequent studies investigated the potential of applying NEXUS criteria to the paediatric populations and found its sensitivity ranging from 0.57 to 1.0 and specificity ranging from 0.2 to 0.54. Additionally, the studies reported a wide range in confidence interval (0.18-0.91), which indicates the possibility of false negative results when NEXUS criteria are applied to this population.

Radiopaedia

The NEXUS criteria have a sensitivity of 99.6% for ruling out cervical spine injury in the original study validating the criteria (95% confidence interval, 98.6-100%). The NEXUS criteria may not be reliable with patient >65 years of age, however. There is some debate over whether the NEXUS criteria or the Canadian C-spine rules (CCR) are more reliable for excluding C-spine injury, though high-quality evidence points to better sensibility, better sensitivity, and a lower rate of imaging use when following the CCR criteria.