Stabilization of the spine with rigid collars has been well established as a useful early intervention for preventing spinal cord injuries among trauma patients.1 Clinical examination and, in some cases, radiographic evidence showing the absence of clinically significant injuries are routinely required prior to making decisions regarding the removal of these collars, a process known as cervical spine clearance.2 Because thorough clinical examinations require intact sensorium and sobriety, there have been debates on the safety of cervical spine clearance among intoxicated patients. 2 The study by Bush et al 3 in this issue of JAMA Surgery is an impressive effort to prospectively evaluate the accuracy of using only computed tomographic (CT) scans as the basis for excluding potential spinal cord injuries among intoxicated trauma patients. Using a single institution's data, this study showed that a normal CT finding alone could predict the absence of significant spinal injuries in more than 99% of cases. 3 The results of this study suggest that it is unnecessary to delay cervical spine clearance until intoxicated patients are sober or until magnetic resonance imaging is performed. However, caution must be taken in making conclusions based on these data. Although the authors conducted the study at an institution with high-quality CT technology and well-trained radiologists, they still recorded a false-negative CT report consistent with a misread. With the higher potential for this nature of error in lower-resourced settings, it becomes important to compare the costs and benefits of early removal of cervical collars. Bush et al 3 showed that the average cervical spine clearance times were 6 to 12 hours longer among intoxicated patients compared with sober patients, presumably equivalent to the time required to become sober. The increased risk of pressure ulcers, which is the most commonly reported adverse effect associated with prolonged collar use, has been demonstrated only in patients who remain in cervical collars for more than 24 hours. 2 However, among the relatively small proportion of patients who may have missed injuries based on CT alone, the potential spinal cord injuries associated with premature cervical spine clearance could lead to long-term disability and even death. 4 With our knowledge that intoxicated patients form up to half of the population of trauma patients, 3is it really safe to risk irreversible injuries in 1% of the population to save a few hours in cervical clearance times? Without doubt, this study echoes the conclusions of previous studies regarding the low utility of subsequent magnetic resonance imaging following normal CT results. 5,6 In this era of cost containment, this provides additional evidence for the avoidance of unnecessary diagnostic tests. Whether these results preclude the need for a thorough clinical examination in an intoxicated trauma patient remains a question that may be too soon to answer.