Healthcare & Clinical
NEXUS Cervical-Spine Trauma Clearance Criteria (5-Item NSAID Rule)
Evaluate Hoffman's 34,069-patient National Emergency X-Radiography Utilization Study (NEXUS) 5-item criteria to safely clear blunt trauma cervical-spine imaging with 99.6% sensitivity.
Clear low-risk blunt trauma C-spines clinically only when ALL FIVE NEXUS criteria are absent!
Validated across 34,069 blunt trauma patients by Hoffman et al. (NEJM, 2000) with 99.6% sensitivity for clinically significant cervical-spine injury, the NEXUS Low-Risk Criteria allow safe clinical C-collar clearance WITHOUT CT or radiographs ONLY when ALL FIVE abnormal findings are ZERO (often remembered via the "NSAID" mnemonic): (1) Posterior midline cervical-spine tenderness, (2) Focal neurologic deficit, (3) Altered level of alertness (GCS < 15 or disorientation), (4) Evidence of intoxication, and (5) Painful distracting injury (such as a long-bone fracture or visceral trauma)!
Because NEXUS is a strict zero-tolerance rule-out tool, SUM(B2:B6) = 0 clears imaging ("NEXUS Low-Risk: C-Spine Imaging Not Required"), whereas ANY single positive finding (SUM >= 1) mandates cervical spine imaging!
| Trauma Presentation | NEXUS Risk Flags (B2:B6) | Positive Flag Sum | Clinical Clearance Decision |
|---|---|---|---|
| Alert Sober Rear-End MVC | All 5 flags = 0 | 0 of 5 | NEXUS Cleared: No C-Spine Imaging Needed |
| Midline Neck Tenderness Only | Midline Tenderness = 1 | 1 of 5 | Not Cleared: C-Spine Imaging Indicated |
| Femur Fracture (Distracting Injury) | Distracting Injury = 1 | 1 of 5 | Not Cleared: C-Spine Imaging Indicated |
NEXUS Positive Risk Flag Count (0 to 5 Flags)
Validates that all five NEXUS flags in B2:B6 are binary (0 or 1) before summing.
=IF(OR(MIN(B2:B6) < 0, MAX(B2:B6) > 1), "Invalid Binary Flag (0 or 1)", SUM(B2:B6))NEXUS Clinical C-Spine Clearance Verdict
Clears cervical imaging ONLY when SUM(B2:B6) = 0.
=IF(OR(MIN(B2:B6) < 0, MAX(B2:B6) > 1), "Invalid Binary Flag (0 or 1)", IF(SUM(B2:B6) = 0, "NEXUS Cleared: C-Spine Imaging Not Required", "Not Cleared: C-Spine Imaging Indicated"))Try the example
Use the original values or change them to test your understanding.