• To assist officers in clinically clearing the spine

NEXUS Clinical Decision Rule (CDR)

 Patient Factors & Considerations
  • C-Spine assessment is performed using clinical judgement and findings from examinations, the NEXUS Clinical Decision Rule can be used to aid this decision.
  • Prior to clearance a thorough primary/secondary and Neurological survey must be completed.
  • Asses high risk factors that limit the ability to clear C spine, utilise a SPEED assessment when high risk factors are present
  • Patients with no neurological deficit may self-extricate short distances (a few steps)
  • Careful clinical judgment should be used, if self-extrication is likely to aggravate the injury then alternative methods of extrication should be used.
  • Ensure a Lanyard is placed and education is given on self-splinting prior to self-extrication.
  • Once on the stretcher apply head blocks and treat although a spinal injury is present.

High risk factors include:

  • Age: Older than 65 years
  • Known pre-existing spinal conditions (e.g. ankylosing spondylitis, rheumatoid arthritis, spinal surgery, spinal stenosis etc.)
  • Dangerous mechanism(s) of injury, including but not limited to:
    • Fall: ≥ 1 meter OR 5 stairs
    • High axial loading to the head (e.g. diving, rugby scrum, surfing etc.)
    • Motor Vehicle Collision at high speed (≥ 60km/hr)
    • Motor Vehicle Rollover
    • Ejection from a vehicle
    • Accidents involving motorised recreational vehicles (e.g. quad-bikes, ATV's, motorbikes, etc.)
    • Bicycle collision
    • Pedestrian/s struck by vehicle
  • Abnormal neurological status
    • Obvious or subtle numbness, tingling or strength deficit in peripheries which was not present prior to the incident/injury
    • Abnormal neurological status which occurred prior to Ambulance arrival must be taken into account in conjunction with a SPEED assessment and consideration of a Dangerous mechanism of injury. Document score and findings 

The NEXUS criteria stipulates that cervical spine injury cannot be excluded if any of the following criteria are present:

  1. Posterior midline cervical spine tenderness:
    • Tenderness is considered present in the following circumstances:
      • Pain on palpation of the posterior midline cervical spine from nuchal ridge to the prominence of the first thoracic vertebra OR
      • Pain on direct palpation of any cervical spinous process
  2. Altered Mental Status (including any of the following):
    • Glascow Coma Scale ≤ 14 OR
    • Disorientation to time, place, person or events (TPPE) OR
    • Inability to remember three simple objects at five minutes OR
    • Delayed or inappropriate response to external stimuli
  3. Focal neurological deficit:
    • Determined to be ANY abnormality, be it sensory or motor on examination, either reported by the patient or elicited by the examiner
      CAUTION: Do not look for alternative explanations for neurological deficit; if present, assume spinal cord injury
  4. Evidence of intoxication (including but not limited to):
    • Recent history reported by the patient or an observer of ingestion/consumption of an intoxicating substance (including but not limited to alcohol) OR
    • Physical exam results indicative of intoxication such as:
      • Odour of alcohol
      • Slurred speech
      • Ataxia
      • Dysmetria or other cerebellar findings
      • Behaviour consistent with intoxication
      • Tests of bodily secretions which are positive for drugs (including but not limited to alcohol) that affect mental alertness
  5. Painful distracting injuries
    • Painful distracting injuries can be considered as any condition thought by the clinician to be producing pain sufficient to distract the patient from a second (neck) injury. This may include (but is not limited to):
      • Any suspected long-bone fracture
      • Large lacerations
      • Degloving; Crush injury
      • Significant Burns
      • Any other injury causing functional impairment
  6. Following the NEXUS assessment a SPEED assessment should be conducted to rule out spinal cord injury

Click to expand

Spinal care changes_Clinical_A3 poster_FINAL Quick Chart
  • Discontinue if patient non-compliant or not tolerant of hard collar and opt for manual in-line stabilisation or head-blocks only.
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