Use NEXUS for adults and adolescents with acute blunt head or neck trauma in emergency or acute care settings when cervical spine injury is a concern and the patient can be examined reliably. It is not designed for penetrating trauma, obvious spinal cord injury or rapidly deteriorating neurology.

Evidence and context

Source	Population/setting	Key findings
Hoffman et al. 2000 (NEXUS)	34,069 blunt trauma patients at 21 US emergency departments, all imaged	818 patients (about 2.4%) had cervical spine injury. When all five low-risk criteria were absent, sensitivity was about 99% for any cervical spine injury and 99.6% for prospectively defined clinically significant injury, with a negative predictive value of 99.9% and low specificity (about 13%). Radiography could have been avoided in roughly 13% of patients if the rule had been used to omit imaging.
Michaleff et al. 2012 systematic review	15 studies evaluating NEXUS and the Canadian C-spine rule	Across validation studies, NEXUS sensitivity for clinically important cervical spine injury ranged from 0.83 to 1.00, with specificity from 0.13 to 0.46. Negative results substantially reduced the post-test probability of injury, but many patients without injury still underwent imaging. The Canadian C-spine rule was generally more specific while maintaining high sensitivity.
Older adult and local data	Elderly low-level falls cohorts and Australian practice	In patients ≥65 years with ground-level or low-level falls, studies report a higher prevalence of cervical spine injury and reduced NEXUS sensitivity, so many services favour liberal CT imaging in this group. Australian guidance recommends using NEXUS or the Canadian C-spine rule to select patients for imaging, with CT as first-line in most adults and plain radiographs mainly for children or where CT is unavailable. Local MRI-based work shows that a minority of alert, neurologically intact patients with persistent midline tenderness and a normal CT have disc or ligamentous injury requiring ongoing collar use or, occasionally, surgery.

Young children were under-represented in derivation and validation studies, and paediatric trauma pathways or age-specific rules are preferred for pre-adolescent patients.

NEXUS Criteria for Cervical Spine Imaging