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NEXUS criteria (cervical spine)

Identifies blunt-trauma patients at very low cervical injury risk, in whom radiography or CT may be omitted.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

NEXUS/Hoffman 2000: 5 low-risk criteria; original cervical rule

The NEXUS 2000 rule was studied in patients undergoing cervical radiography after blunt trauma. Low-probability classification requires all five criteria simultaneously; the study reported injuries missed by the rule, so a negative result is not certainty of no injury. Age, exclusions and subgroup application must be checked in the full protocol.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Posterior midline cervical spine tenderness
Focal neurological deficit
Altered level of consciousness
Evidence of intoxication
Painful distracting injury (e.g., long-bone fracture, extensive burn)

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Imaging can be omitted when all criteria are met: no posterior midline tenderness, no focal neurological deficit, normal alertness, no intoxication and no painful distracting injury. Any positive finding indicates imaging.

References

Identifier: nexus-coluna-cervical

Original clinical content: Brazilian Portuguese.

Method version

NEXUS/Hoffman 2000: 5 low-risk criteria; original cervical rule

nexus-coluna-cervical@native-2026-10-03+d3b3b6a1339b

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Posterior midline cervical spine tenderness: No
Focal neurological deficit: No
Altered level of consciousness: No
Evidence of intoxication: No
Painful distracting injury (e.g., long-bone fracture, extensive burn): No

{
  "dor": false,
  "deficit": false,
  "alerta": false,
  "intox": false,
  "distrativa": false
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 2

reference-002

Inputs

Posterior midline cervical spine tenderness: Yes
Focal neurological deficit: No
Altered level of consciousness: No
Evidence of intoxication: No
Painful distracting injury (e.g., long-bone fracture, extensive burn): No

{
  "dor": true,
  "deficit": false,
  "alerta": false,
  "intox": false,
  "distrativa": false
}

Expected result

{
  "score": 1,
  "level": "high"
}

Actual result

{
  "score": 1
}

Case 3

reference-003

Inputs

Posterior midline cervical spine tenderness: Yes
Evidence of intoxication: Yes
Painful distracting injury (e.g., long-bone fracture, extensive burn): Yes
Focal neurological deficit: No
Altered level of consciousness: No

{
  "dor": true,
  "intox": true,
  "distrativa": true,
  "deficit": false,
  "alerta": false
}

Expected result

{
  "score": 3,
  "level": "high"
}

Actual result

{
  "score": 3
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.