Rules and Scoring Systems

Question 1

NEXUS Criteria

6 criteria

Answer 1

1. Alert and Stable
2. No focal neurologic deficit
3. No altered level of consciousness
4. Not intoxicated
5. No midline spinal tenderness
6. No distracting injury

Sensitivity of 99.6% for ruling out cervical spine injury; specificity 12.9%

Question 2

Canadian C-Spine Criteria

High Risk Criteria (requires imaging)

Answer 2

Age ≥65yo
Dangerous Mechanism
- fall from >0.9m or 5 stairs
- axial load to the head
- high speed MVA (>100km/hr), rollover, or ejection
- motorised recreational vehicles
- bicycle collision

Paraesthesias in extremities

Question 3

Canadian C-Spine Criteria

Low Risk Criteria

Answer 3

Simple rear-ended MVA (excluding large vehicle)
Sitting position in Emergency Department
Ambulatory at any point following injury
Delayed onset neck pain
Absence of midline C-spine tenderness

If able to rotate neck to 45 degrees each side then no imaging required; unable to rotate neck 45 degrees requires imaging

If low risk criteria not met, then patient requires imaging

High sensitivity

Question 4

Canadian C-Spine Exclusion Criteria

Answer 4

• Non-trauma patients
• GCS 15
• Unstable Vital Signs
• Age <16yo
• Acute Paralysis
• Known vertebral disease