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Which of the following criteria cannot clear the cervical spine (c-spine) according to the NEXUS criteria?
Altered Level of Consciousness (LOC)
Presence of midline tenderness
Intoxication above 20/hour
Normal neurologic findings
The correct answer is: Intoxication above 20/hour
The NEXUS criteria are guidelines used to determine whether cervical spine imaging is necessary in patients who have sustained blunt trauma. One of the key components of these criteria is to identify specific conditions that may indicate a higher risk of cervical spine injury. Altered Level of Consciousness is a critical factor because it may impair a patient's ability to provide an accurate history or may indicate a neurological compromise. Presence of midline tenderness is also significant as it suggests possible underlying injury to the cervical spine. Furthermore, intoxication can similarly affect cognitive function and patient assessment. Intoxication, particularly at or above a certain threshold, can indeed impair judgment and alter the level of consciousness, making it difficult to assess whether the patient has suffered a significant injury or is able to provide coherent history. Thus, this factor does not meet the criteria for cervical spine clearance as the patient's intoxicated state can mask symptoms of injury. Normal neurologic findings, on the other hand, indicate that there is no neurological deficit, which generally supports the determination that cervical spine injuries are less likely. Therefore, this characteristic does not hinder a clinician's ability to rule out the need for imaging. In summary, a state of intoxication above a threshold compromises the evaluation of cervical spine injury, thereby not