Table 1.

– Clinical evidence evaluating the efficacy of NEXUS and CCR and guidelines available in literature.

Author	Study methodology	Level of evidence	Sample size	Sensitivity	Specificity	Missed on X-Rays	Comment/Remarks
Mathen 2007	MCT vs X-Rays	Prospective case series—level 4	667	100% vs 45%	99.5% vs 97.4%	15 of 27 (55.5%)	MCT outperformed plain radiography as a screening modality for the identification of acute c-spine injury in trauma patients
Diaz JJ 200515	HCT vs X-Rays	Prospective case series—level 4	1577	32% vs 16%a		299 of 416 (72%)	Helical CT is not only sensitive and specific but also cost-effective tool for screening cervical spine bony injuries. For ligamentous injuries, MRI is superior to CT
Diaz JJ 200314	CT scan vs X-Rays	Prospective case series—level 4	1006	97.4% vs 44%	100% vs 100%	90 of 172 (52.3%)	CTS outperformed five-view CSX in a group of patients with altered mental status or distracting injuries.
Holmes 200512	CT scan vs X-Rays	Meta-analysis—level 3		98% vs 52%			CT significantly outperforms plain radiography as a screening test
Beckman 2019	ACR guidelines	Level 5					CT is the preferred screening modality in blunt trauma patients when indicated with NEXUS or CCR
Kortbeek JB 200846	ATLS guidelines	Level 5					CT is the preferred screening modality in blunt trauma patients at high and moderate risk of cervical spine fractur
Ackland 201216	RACP guidelines	Level 5					CT is the preferred imaging. Five-view plain X-ray to be done if CT is unavailable. MRI should be considered in patients with neurologic symptoms or advanced cervical degenerative disease.

^aValues only for ligamentous injury.