patient does not have a high-risk mechanism of injury (motor vehicle accident, fall >10 ft, dive, or sports injury), is awake and alert, can have an interactive conversation (not inebriated, no altered level of consciousness, verbal at baseline), does not complain of cervical spine pain, has no tenderness on palpation (especially in the posterior midline), has normal neck mobility, has a completely normal neurologic examination without a history of abnormal neurologic symptoms or signs at any time after the injury, and has no other painful injuries (which may distract the patient and mask neck pain), the patient may not need radiographic evaluation of the cervical spine The National Emergency XRadiography Utilization Study (NEXUS) suggests the following criteria for the assessment of risk of spinal injury: (i) midline cervical tenderness, (ii) intoxication, (iii) alertness, (iv) focal neurologic deficit, and (v) distracting (painful) injury (i.e., long bone fracture, visceral injury, large laceration, degloving or crush injury, large burns, and injuries producing impairment in appreciation of other injuries) If these are negative, then the patient is believed to be at low risk for a spinal injury and may be able to forgo radiographic evaluation In adults, NEXUS low-risk criteria have been reported to be 99.6% sensitive in the detection of clinically important cervical spine injury and have a high NPV for low-risk patients When NEXUS criteria were applied to children