Improving Practice

Jacobson, Therese; Tescher, Ann N.; Miers, Anne G.; Downer, Lisa L.

doi:10.1097/01.ncq.0000324595.29956.90

Cited by 29 publications

(9 citation statements)

References 13 publications

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“…Information was extracted from each study on tissue interface pressures (14 papers included [4,5,10,13-23]) and jugular venous measurements (14 papers included [6-10,24-32]) in association with cervical immobilisation devices (Figure 1). One paper [10] was included in both searches.…”

Section: Resultsmentioning

confidence: 99%

“…Jacobsen et al determined that whilst only 1% of all occipital pressure ulcers are attributable to the use of a rigid cervical collar [5], the incidence of hospital acquired pressure ulcer ranges from 23.9% to 44%. They also noted that collar-related pressure ulcers may develop at various locations on the body; but occipital pressure ulcers are the most serious because there is very little subcutaneous tissue over the bone, confirming the work of Molano et al [15].…”

Section: Resultsmentioning

confidence: 99%

“…In a healthy and non-spinally injured patient continuous contact with the collar, and the resulting tissue interface pressures, can lead to early tissue breakdown and ulceration [4]. This is even more problematic in the presence of an actual spinal injury, due to lack of neural tone and decreased blood flow to the affected area [5]. As a result, the onset of ulceration and tissue breakdown is more rapid in patients where it is least desirable.…”

Section: Introductionmentioning

confidence: 99%

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The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review

Sparke¹,

Voss

Benger

2013

Scand J Trauma Resusc Emerg Med

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Cervical immobilisation is commonly applied following trauma, particularly blunt head injury, but current methods of immobilisation are associated with significant complications. Semi-rigid disposable cervical collars are known to cause pressure ulcers, and impede effective airway management. These collars may also exacerbate a head injury by increasing intracranial pressure as a result of external compression of the jugular veins. There is a clear imperative to find ways of effectively immobilising the cervical spine whilst minimising complications, and any assessment of existing or new devices should include a standardized approach to the measurement of tissue interface pressures and their effect on jugular venous drainage from the brain. This systematic review summarises the research methods and technologies that have been used to measure tissue interface pressure and assess the jugular vein in the context of cervical immobilisation devices. 27 papers were included and assessed for quality. Laboratory investigations and biomechanical studies have gradually given way to methods that more accurately reflect clinical care. There are numerous accounts of skin ulceration associated with cervical collars, but no standardised approach to measuring tissue interface pressure. It is therefore difficult to compare studies and devices, but a pressure of less than 30 mmHg appears desirable. Cervical collars have been shown to have a compressive effect on the jugular veins, but it is not yet certain that this is the cause of the increased intracranial pressure observed in association with cervical collar use. This is the first review of its type. It will help guide further research in this area of trauma care, and the development and testing of new cervical immobilisation devices.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review

Sparke¹,

Voss

Benger

2013

Scand J Trauma Resusc Emerg Med

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“…Occipital pressure sores are immobility-related areas of tissue damage and hair loss that are developed at the back of the head. In historical civilian trauma cohorts, such ulcers were seen in approximately 1% of casualties, [1]. Occipital pressure sores in such circumstances were associated with the use of rigid cervical collars and pre-hospital spinal immobilisation, [2].…”

Section: Introductionmentioning

confidence: 99%

Understanding occipital pressure sores in UK military casualties: a pilot study in healthy military personnel

et al. 2023

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IntroductionThe high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist. To address this gap in knowledge, we propose to use the time it takes for a healthy person to feel pain at the back of the head as an initial indication of safe exposure to pressure.MethodsHealthy military personnel (16 male/10 female) were asked to lie motionless on a typical general service stretcher until they felt pain. Time-to-pain and the location of pain were recorded. To support the interpretation of results, baseline sensitivity to pain and pressure distribution at the back of the head were also measured. Independent samples t-test was used to assess differences between genders.ResultsTwenty participants felt pressure-induced soft-tissue pain at the back of the head. The remaining six participants terminated the test due to musculoskeletal pain caused by poor ergonomic positioning. On average, pain at the occiput developed after 31 min (±14 min). Female participants were significantly more sensitive to pain (t(24)=3.038,p=0.006), but time-to-pain did not differ significantly between genders (p>0.05).ConclusionsWhen people lie motionless on a typical military stretcher, the back of the head is the first area of the body that becomes painful due to pressure. The fact that pain develops in ≈30 min can help healthcare providers decide how frequently to reposition their patients who are unable to do this on their own. More research is still needed to directly link time-to-pain with time-to-injury.

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“…[1] These are associated with various factors, and may vary from nonblanching skin erythema to loss of all layers of scalp, exposing underlying bone. [23] Pressure ulcers in this area may not permit standard midline incision, creating an impasse for the surgical management.…”

mentioning

confidence: 99%

Posterior approach to suboccipital- craniovertebral junction in patients with occipital pressure ulcer - Proposal of Y shaped occipito-cervical incision

et al. 2014

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Improving Practice

Cited by 29 publications

References 13 publications

The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review

The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review

Understanding occipital pressure sores in UK military casualties: a pilot study in healthy military personnel

Posterior approach to suboccipital- craniovertebral junction in patients with occipital pressure ulcer - Proposal of Y shaped occipito-cervical incision

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