NEXUS Criteria for C-Spine Imaging

When it activates

Scribeable activates a calculator from the encounter. The NEXUS Criteria for C-Spine Imaging can activate when the transcript or pasted chart context documents any of these:

• Cervical spine clearance
• C-spine imaging decision in trauma
• Neck injury evaluation
• Trauma without neck pain

Note-type scope: it activates on notes whose subject resolves to emergency medicine, hospital medicine. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

5 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.

Scoring

C-spine can be cleared (no imaging) if ALL 5 criteria are ABSENT: (1) Focal neurological deficit, (2) Posterior midline c-spine tenderness, (3) Altered level of alertness, (4) Intoxication, (5) Distracting painful injury. Score: 0 = c-spine cleared (all absent), 1 = imaging needed (any present).

Interpretation

All 5 criteria absent: C-spine can be cleared clinically without imaging (sensitivity 99.6% for significant injury, NPV 99.9%). Any criterion present: Imaging required. NEXUS is applicable to blunt trauma patients of all ages.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Hoffman JR et al. 2000.

• Hoffman JR et al. Validity of a set of clinical criteria to rule out injury to the cervical spine (NEXUS)Hoffman et al. (NEXUS) 2000 · 2000 · Level I · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the NEXUS Criteria for C-Spine Imaging (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.

The score is computed in code from the resolved inputs, not recalled by the language model. A stated NEXUS Criteria for C-Spine Imaging value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.

Classified as a mandatory rule-out score: a missed result carries acute harm, so the activation filter never approves it on uncertainty.

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Can activate in: Emergency Medicine.