Spine
Cervical spine trauma
Blunt cervical spine trauma is triaged for imaging with one of two validated decision rules, both around 99% sensitive for clinically significant injury but differing in how much imaging they avoid.
What you are actually deciding
The Canadian C-Spine Rule has both higher sensitivity and higher specificity than NEXUS in direct comparison, so it avoids more imaging. NEXUS is simpler to remember. Both require an alert, assessable patient and neither covers penetrating trauma.
Clinical decision rule2
- Canadian C-Spine Rule3 itemsCanadian C-Spine RuleThe Canadian C-Spine Rule decides whether an alert, stable blunt trauma patient needs cervical spine radiography through three sequential steps — high-risk factors, low-risk factors, and the ability to actively rotate the neck 45 degrees each way — with a reported sensitivity of about 99% for clinically significant injury.
- NEXUS Rules5 itemsNEXUS Low-Risk Criteria for Cervical Spine ImagingThe NEXUS low-risk criteria allow the cervical spine to be cleared without imaging after blunt trauma when all five findings are absent — midline cervical tenderness, focal neurological deficit, altered alertness, intoxication and a distracting injury — with a reported sensitivity of about 99% for clinically significant injury.