“…A positive association between length of stay and collar-related pressure ulceration was reported in 1 study. 25 Figure 6.Bivariate regression analysis of pressure ulcer frequency as a function of mean duration of immobilisation.…”
Section: Resultsmentioning
confidence: 99%
“…A positive association between length of stay and collar-related pressure ulceration was reported in 1 study. 25…”
Study Design Systematic review and meta-analysis. Objective To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar. Methods Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies. Results The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication. Conclusions There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.
“…A positive association between length of stay and collar-related pressure ulceration was reported in 1 study. 25 Figure 6.Bivariate regression analysis of pressure ulcer frequency as a function of mean duration of immobilisation.…”
Section: Resultsmentioning
confidence: 99%
“…A positive association between length of stay and collar-related pressure ulceration was reported in 1 study. 25…”
Study Design Systematic review and meta-analysis. Objective To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar. Methods Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies. Results The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication. Conclusions There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.
“…Pressure ulcers developed unnecessarily in seven patients in our study, who all eventually had their collars removed based on a normal CT scan of the neck. It is clear from work in elderly patients, that having a cervical collar in place for greater than 24 hours increases the complication rate (23).…”
Background: Cervical spine clearance in intubated victims of blunt trauma remains contentious; accumulating high level evidence suggests that a normal CT cervical spine can be used to clear the c-spine and remove the collar in obtunded emergency department patients to prevent collar-related complications. However, it is unclear whether this holds true for intubated patients in the trauma intensive care unit (TICU).Methods: We performed a retrospective review of 730 intubated trauma patients who presented to the Level 1 Trauma center of a tertiary hospital. We reviewed the rate of missed cervical injuries in patients who had their cervical collars removed based on a normal computed tomography (CT) scan of the cervical spine, as well as rates of collar-related complications.Results: Three hundred and fifty patients had their cervical collars removed in the TICU based on the findings of a high-quality, well-interpreted normal CT cervical spine. Seventy percent of patients were intubated and sedated at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%.Conclusion: Based on our findings, it is safe to remove the cervical collar for patients in the TICU following normal CT cervical spine, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be related to increased complications. We provide an algorithm to assist critical-care clinicians in decision-making in this patient cohort
“…It should always be kept in mind when assessing the need for a cervical collar, that approximately 5% of patients with TBI have an associated spinal injury, and about 25% of patients with spinal injury have at least a mild TBI. 14,15,21 The AANS/CNS Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injury list clinical criteria to select appropriate patients for spinal immobilization: 14 (1) spinal pain or tenderness, including any neck pain with a history of trauma, (2) significant multiple system trauma, (3) severe head or facial trauma, (4) numbness or weakness in any extremity after trauma, (5) loss of consciousness caused by trauma, (5) If the mental status is altered (including drugs, alcohol, trauma) and no history is available, or the patient is found in a setting of possible trauma (e.g., lying at the bottom of stairs or in the street); or the patient experienced near-drowning with a history or probability of diving, and (6) any significant distracting injury.…”
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