This week on Briefs I wanted to present – with limited comment – a synopsis of the NEXUS and Canadian C-Spine rules. In general, the most common reason we end up getting cervical spine films in the Peds ED is for midline C-Spine pain. I trust you’d all agree that it is important to understand why we do this, and can enumerate other reasons to order films for suspected C spine injury. The title of each links to the seminal articles.

NEXUS (National Emergency X-Radiography Utilization Study)
Multicenter, prospective, observational study of patients with blunt trauma for whom cervical spine X-rays were obtained.

Get C-spine films if:

  • Abnormal neurologic examination
  • Distracting or painful injury (like a femur fracture)
  • Depressed or altered mental status
  • Intoxication
  • Midline cervical tenderness

Canadian C-spine rule
A prospective cohort study in Canada evaluating patients with head or neck trauma.

Radiography is definitely recommended in high risk factors

  • Dangerous mechanism
  • Paresthesias

If any of the following low risk factors are present and the patient can actively rotate 45 degrees to left and right, then C-spine films may not be needed.

  • Simple rear-end MVC
  • Sitting position in the ED
  • Ambulatory at any time since injury
  • Delayed onset neck pain
  • Absence of midline C-spine tenderness