Review article: NEXUS criteria to rule out cervical spine injury among older patients: A systematic review

Emerg Med Australas. 2018 Aug;30(4):450-455. doi: 10.1111/1742-6723.12880. Epub 2017 Dec 12.


The National Emergency X-Radiography Utilization Study (NEXUS) criteria were derived from a heterogeneous group of adult blunt trauma patients, with the outcome measure assessed most commonly using plain X-ray radiographs. Recent observations have suggested inadequacy of these criteria for excluding injury in population subgroups such as the elderly. The aim of this systematic review was to determine the sensitivity of the NEXUS criteria in excluding cervical spine injury among older patients aged ≥65 years. A systematic review of the literature published prior to 1 January 2017 that reported on the performance of the NEXUS criteria among older patients was conducted. The databases OVID Embase and OVID Medline were searched. The sensitivity of the NEXUS criteria was recalculated for each study among older patients. There were seven studies included in this review. All studies were considered to be at risk of bias and rated down for quality of evidence. Emergency physicians were assessors in all included studies. Sensitivity of the NEXUS criteria among older patients ranged from 66% to 100%. Variable sensitivity was demonstrated when the NEXUS criteria were applied to older blunt trauma patients. This questions the applicability of the NEXUS criteria in this subgroup.

Keywords: aged; cervical vertebrae; clinical decision-making; decision-support technique; spinal injury.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Cervical Vertebrae / injuries*
  • Cervical Vertebrae / physiopathology
  • Female
  • Humans
  • Male
  • Radiography / methods
  • Radiography / standards*
  • Radiography / statistics & numerical data
  • Spinal Injuries / diagnosis*
  • Tomography, X-Ray Computed / methods