Which of the following patients, evaluated by the NEXUS cervical spine criteria after blunt trauma, REQUIRES cervical spine imaging?
- A A 28-year-old intoxicated man with no neck tenderness and a normal neurological examination ✓
- B A 30-year-old woman with no neck tenderness who has a painful distracting injury to the femur
- C A 25-year-old alert man with no tenderness, no distracting injury, and normal neurological examination
- D A 22-year-old alert man with midline neck tenderness only
Explanation
The NEXUS criteria allow imaging to be deferred only when all five features are absent: midline cervical tenderness, focal neurological deficit, altered level of consciousness, intoxication, and a painful distracting injury. Intoxication alone mandates imaging even if the neck is non-tender, making option A correct. Option B also fails the criteria because a femoral shaft fracture is a classic distracting injury, so imaging is needed there as well. Options D and C are distractors testing whether students know that isolated midline tenderness alone still requires imaging.
Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.