NEXUS Rule Is Less Accurate in Patients Evaluated by Trauma Team

Inadequate attention to the cervical spine in patients with multiple injuries likely explains the poorer results.

The NEXUS rule, validated in a prospective study of more than 34,000 patients in 2000, has been widely adopted by emergency physicians to determine the need for plain cervical spine (C-spine) radiographs in patients sustaining blunt trauma. To assess reliability of the NEXUS criteria in the trauma setting, investigators prospectively evaluated 534 blunt trauma patients older than 16 at a single level I trauma center during 2004. Examiners were blinded to the study. All patients underwent 16-slice helical computed tomography (CT).

Of 52 patients (9.7%) who had cervical fracture detected by CT, 40 (76.9%) were deemed to require CT because they had positive cervical examinations (neck pain, neurologic deficit, tenderness to palpation, or any co…

Reviewing Author

John A. Marx, MD, FAAEM, FACEP