NEXUS Criteria

What are cervical spine injuries?

Cervical spine injuries often result from trauma and can have severe and far-reaching effects, such as long-term disability. Typically, symptoms exhibited by patients with cervical spinal cord injuries are neck pain, stiffness, radiating pain, numbness, or weakness extending from the shoulders to the hands. Generally, the effects or complications of such injuries include loss of sensory function, paralysis, loss of bladder and bowel control, and the inability to perform self-care tasks. Careful assessment and appropriate imaging are crucial, especially to blunt trauma patients, whose risk of cervical spine injury is particularly high.

What is cervical spine imaging?

Cervical spine imaging is crucial in diagnosing and evaluating spinal injuries, such as fractures and muscle strain. It is vital for accurate assessment and appropriate treatment planning. Among the key modalities used are computed tomography (CT scan), magnetic resonance imaging (MRI), and myelography (myelogram).

What is the NEXUS Criteria?

The National Emergency X-Radiography Utilization Study (NEXUS) Criteria are clinical criteria used to assess trauma patients and determine the necessity of cervical spine imaging. These criteria enable clinicians to identify patients who can be safely cleared without imaging, optimizing resource utilization and minimizing unnecessary radiation exposure.

For a patient to be clinically cleared without cervical spine imaging, they must meet all of the following conditions featured in the criteria:

• Absence of midline cervical spine tenderness
• Absence of any distracting injury
• No focal neurologic deficit
• No intoxication
• No altered mental status

The NEXUS low-risk criteria are well-validated and widely used among emergency physicians to facilitate more selective cervical spine radiography, expedite the exclusion of cervical spine injuries in patients, and help ensure that cervical spine injuries are not missed while also preventing unnecessary imaging in patients who do not need it.

How does our NEXUS Criteria template work?

The NEXUS Criteria provides a systematic approach to evaluating trauma patients. Here's guide on how to make the most out of the criteria:

Step 1: Do a patient assessment

Begin by conducting a thorough initial assessment of the trauma patient. Ensure that the patient is stable before proceeding with the NEXUS Criteria evaluation.

Step 2: Evaluate the patient using the NEXUS criteria

After you obtain a copy of the NEXUS Criteria by accessing a copy through the buttons in this guide, go through each criterion. You can follow our step-by-step process below:

• Evaluate the midline spinal tenderness: Gently palpate the cervical spine to check for any midline tenderness to ensure that there is no pain directly over the cervical spine.
• Check for distracting injuries: Assess the patient for any distracting injuries that can potentially mask the pain of a cervical spine injury, such as fractures, burns, or significant lacerations.
• Perform a neurologic examination: Rule out any neurologic deficits by checking for motor and sensory function and reflexes in the upper and lower extremities.
• Assess for intoxication: Use clinical judgment or perform a toxicology screening to evaluate the patient for signs of intoxication via alcohol or drugs.
• Determine mental status: Evaluate your patient's ability to respond appropriately to questions and follow commands to ensure they are fully alert and oriented.

Step 3: Document findings and make a clinical decision

Carefully document all findings from the previous step's assessments in the template and ensure that each criterion is addressed and noted whether the patient meets or does not meet the criteria.

If the patient meets all of the NEXUS Criteria, they can be clinically cleared and don't need cervical spine imaging. However, if they don't meet any, cervical spine imaging should be performed to rule out any potential injuries.

Step 4: Communicate with the patient

Explain the findings and rationale of your decision to the patient as well as the next steps. Afterward, ensue appropriate follow-up care and monitoring to observe symptoms and address them before they worsen.

NEXUS Criteria interpretation

Interpreting the results of the NEXUS Criteria is simple. Patients are considered for clinical clearance without imaging if they meet all of the following criteria: no midline tenderness, no distracting injury, no neurologic deficit, no intoxication, and no altered mental status.

If a patient fulfills all the above criteria, they may be clinically cleared without the need for cervical spine imaging. This implies that further diagnostic imaging, such as X-rays or MRI, is not deemed necessary based on the initial assessment, thereby reducing unnecessary radiation exposure and resource utilization.

However, if the patient fails to meet any one of these criteria, further evaluation and imaging are recommended. This ensures that any potential cervical spine injuries are not missed and that appropriate diagnostic measures are taken to confirm or rule out significant conditions.

Management and treatment of cervical spine injuries

Managing and treating cervical spine injuries requires a tailored approach based on the severity and nature of the injury. Here are essential considerations and approaches:

• Conservative treatment: In cases where cervical spine injury is suspected but not severe, conservative measures such as immobilization, physical therapy, pain management, or heat or cold therapy are typically the first line of treatment.
• Pharmacological treatment: In more severe cases or where conservative measures are insufficient, medications like pain relievers, muscle relaxants, or anti-inflammatory medications may be prescribed by healthcare providers to alleviate pain and reduce inflammation.
• Surgical treatment: For severe injuries, fractures, or cases of spinal instability, surgical intervention like spinal fusion, decompression, or stabilization, may be necessary.

Do note that it's crucial to develop a treatment plan tailored to each patient's specific diagnosis and circumstances.