NEXUS + Canadian C-Spine
NEXUS low-risk cervical-spine criteria (Hoffman JR et al. NEJM 2000): cervical-spine imaging is NOT required when ALL FIVE low-risk criteria are met.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- No posterior midline cervical-spine tenderness
- Yes
- No evidence of intoxication
- Yes
- Normal level of alertness
- Yes
- No focal neurologic deficit
- Yes
- No painful distracting injury
- Yes
Result: All five low-risk criteria met -> NEXUS: cervical spine imaging NOT required.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- No posterior midline cervical-spine tenderness
- No evidence of intoxication
- Normal level of alertness
- No focal neurologic deficit
- No painful distracting injury
What this is
Apply the two validated clinical-decision rules for cervical-spine imaging in alert blunt-trauma patients - NEXUS (no posterior midline tenderness, no intoxication, normal alertness, no focal neurologic deficit, no painful distracting injury) and the Canadian C-Spine Rule (age, mechanism, neck rotation, low-risk features). Sophie Well takes the shared inputs once and reports whether each rule clears the patient for clinical exam alone or recommends imaging.
When to use it
Use this when an awake blunt-trauma patient presents with neck pain or a concerning mechanism and you want to document the rationale for or against c-spine imaging. Both rules are highly sensitive for clinically important cervical-spine injury and can spare imaging in a large fraction of low-risk presentations - the documentation is the protective layer. Neither rule applies to obtunded patients, age extremes outside their derivation cohorts, or polytrauma where a distracting injury cannot be ruled out; in those cases imaging proceeds on clinical grounds regardless of what the rules say.
How this is calculated
Hoffman JR, et al. NEXUS criteria. NEJM. 2000;343(2):94-99. Stiell IG, et al. Canadian C-Spine Rule. JAMA. 2001;286(15):1841-1848. Read the sources: Hoffman 2000 ↗, Stiell 2001 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.
More in Triage and acuity.