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Here, the number of unnecessary CT cervical studies despite proper application of NEXUS criteria was assessed. The authors also tried to determine indications for ordering studies in the absence of guideline criteria. Of 507 CT studies, only 5 (1%) were positive while 81 of the 502 patients with negative findings (16%) were imaged despite meeting all NEXUS criteria for non-imaging. The most common indications for the studies were a dangerous mechanism of injury and subjective neck pain. Strict application of NEXUS criteria may result in considerable reduction of screening CT studies of the cervical spine.