Which item is NOT part of the NEXUS criteria for spinal immobilization?

Which item is NOT part of the NEXUS criteria for spinal immobilization?

• A. Midline cervical spinal tenderness
• B. Focal neurological deficit
• C. Altered mental status
• D. Shortness of breath

Answer: (D)

The question tests understanding of what the NEXUS criteria include for clearing the cervical spine. NEXUS is a set of five clinical factors used to decide whether a patient with potential cervical spine injury can be safely cleared without imaging. If all five criteria are met—no midline cervical spine tenderness, no focal neurological deficit, normal mental status (alert and oriented), no intoxication, and no distracting injuries—then the patient is considered low risk for cervical injury and immobilization or radiography may not be needed. If any one of these factors is present, imaging is indicated and immobilization should be continued until injury is ruled out. Midline cervical spine tenderness and focal neurological deficits are both red flags in these criteria, so they are part of the assessment. Altered mental status violates the normal alertness criterion and is also part of the decision. Shortness of breath, however, is not one of the five NEXUS criteria. It may be important clinically, but it doesn’t factor into the decision framework for clearing the cervical spine under NEXUS. That’s why shortness of breath is not part of the NEXUS criteria.

The question tests understanding of what the NEXUS criteria include for clearing the cervical spine. NEXUS is a set of five clinical factors used to decide whether a patient with potential cervical spine injury can be safely cleared without imaging. If all five criteria are met—no midline cervical spine tenderness, no focal neurological deficit, normal mental status (alert and oriented), no intoxication, and no distracting injuries—then the patient is considered low risk for cervical injury and immobilization or radiography may not be needed. If any one of these factors is present, imaging is indicated and immobilization should be continued until injury is ruled out.

Midline cervical spine tenderness and focal neurological deficits are both red flags in these criteria, so they are part of the assessment. Altered mental status violates the normal alertness criterion and is also part of the decision. Shortness of breath, however, is not one of the five NEXUS criteria. It may be important clinically, but it doesn’t factor into the decision framework for clearing the cervical spine under NEXUS. That’s why shortness of breath is not part of the NEXUS criteria.