Which of the following is NOT a component of the NEXUS criteria?

The NEXUS criteria are a set of clinical guidelines used primarily to determine whether a cervical spine injury is likely in a trauma patient, particularly when assessing the need for spinal immobilization. The main components that must be assessed are:

• Midline tenderness, which indicates a potential injury to the spinal column.
• Altered level of consciousness, as it suggests a possible significant head injury or other critical conditions that could influence decision-making regarding the spine.
• The presence of distracting injuries, which can divert a patient's attention away from other painful injuries, potentially masking a neck injury.

Pain in the extremities is not part of the NEXUS criteria and therefore does not directly relate to the determination of spinal injury risk. The focus of NEXUS is on specific indicators that may suggest a higher risk of significant cervical spine injury, rather than general pain in the limbs, which does not indicate any specific condition regarding the cervical spine itself. Thus, the correct response identifies a factor that does not pertain to the critical evaluation of spinal status in trauma patients as outlined by the NEXUS guidelines.