Which of the following is NOT a component of the NEXUS criteria for clearing the cervical spine?

• A. Absence of intoxication
• B. Absence of midline cervical tenderness
• C. Absence of focal neurologic impairment
• D. Absence of fever

Answer: (D)

The question tests which clinical findings are used to clear the cervical spine without imaging using the NEXUS criteria. NEXUS relies on five findings being absent: absence of posterior midline cervical tenderness, absence of evidence of intoxication, the patient being alert and oriented (no altered mental status), absence of focal neurological deficits, and absence of distracting injuries. Fever is not among these criteria. Fever doesn’t reliably indicate whether the cervical spine is injured, so it isn’t a factor in deciding radiographic clearance. In practice, if all five NEXUS criteria are met, the spine can be cleared clinically, even if a patient has a fever, because fever doesn’t affect the predictive value for cervical spine injury.