Úlceras por presión secundarias a la inmovilización con collarín cervical: una complicación de la lesión cervical aguda

Álvarez, E. Molano; Pérez, María del Ara Murillo; Villegas, M.T.; Caballero, Mireia Domínguez; Solanas, M. Cuenca; Fuentes, C. García

doi:10.1016/s1130-2399(04)78152-3

Cited by 11 publications

(8 citation statements)

References 40 publications

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“…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]. Jacobsen et al also drew attention to cases where the application of cervical collars exerted a pressure greater than the capillary closing pressure, thus restricting blood flow to contact areas, exacerbating the problem.…”

Section: Resultsmentioning

confidence: 64%

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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: 64%

“…60) . Molano et al also identified pressure sores as a complication of collar use following a review of patients admitted with an acute cervical spine injury [15]. Pressure sores developed most frequently at occipital, chin and supra-scapular zones; with occipital injuries the most severe.…”

Section: Resultsmentioning

confidence: 99%

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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“…The prevalence of CS collar complications in adults is reported in the range of 7-23%, 9,10 and CS collar complications correlate with higher ISS and increased days of ventilation and intracranial pressure monitoring. 10 The median day for CS clearance was 2 days for those patients who had neither CS injuries nor collar complications. A fast CS clearance time is imperative and clinical CS clearance is ideal, but our rates were relatively low at 13% (adults 20%), 13 likely due to the higher severity of injuries in our trauma population.…”

Section: Discussionmentioning

confidence: 97%

“…1,8 Early CS clearance is important to avoid CS collar complications and facilitate optimal patient care. In adults, the prevalence of skin breakdown and ulcers with prolonged use of CS collars ranges from 7 to 23%, 9,10 and CS collar complications are associated with increased length of stay, greater morbidity and increased costs of care. 11,12 Paediatric severe trauma patients are among those with the greatest risk of both CS injuries and prolonged use of CS collars.…”

Section: Introductionmentioning

confidence: 99%

Cervical spine injuries and collar complications in severely injured paediatric trauma patients

et al. 2013

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Study design: A retrospective registry review. Objectives: To determine the incidence of cervical spine (CS) injuries and collar complications in severely injured paediatric trauma patients. Setting: Regional Trauma Centre, Children's Hospital. Methods: A retrospective review of 365 paediatric severe trauma patients (0-17 years), defined as an Injury Severity Score (ISS)X12, admitted to the paediatric intensive care unit (PICU). Results: Clinically significant CS injuries occurred in 5% (n ¼ 18/365) of trauma patients, in 9% (n ¼ 13/149) of traumatic brain injury (TBI) patients and in 11% (n ¼ 6/56) of in-hospital trauma deaths. CS injuries were suspected before imaging in 33% (n ¼ 6/ 18) of patients based on either motor/sensory impairment or shock. CS injuries were deemed unstable in 61% (n ¼ 11/18) of patients. Patients with CS injuries had higher ISS, and longer PICU and hospital stays (Po0.05). CS collar complications occurred in 10% of patients, mainly identified by day 6 and consisting of either erythema or ulcers. Patients with CS collar complications were older and more likely to have TBI, lower Glasgow Coma Scale (GCS) scores, longer PICU and hospital stays, and increased days to CS clearance (Po0.05). Three CS X-rays, together with flexion/extension views, were used most frequently for CS clearance. Conclusion: CS injuries were prevalent in severely injured paediatric trauma patients, particularly in those with TBI and in nonsurvivors. CS collar complications were associated with a lower GCS and longer CS clearance times. Attention to CS collar management protocols and earlier CS clearance with computed tomography/magnetic resonance imaging in obtunded patients might reduce CS collar complications.

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“…3 In a 6-year national study of acute care facilities, the incidence of pressure ulcers ranged from 7 to 9%. [7][8][9] Studies have shown that the incidence of pressure ulcers is higher for those patients who remained in the cervical collar for longer periods of time. 5 Although only 1% of all pressure ulcers occur on the occipital area, 6 for patients wearing a cervical collar the incidence of pressure ulcers ranges from 23.9 to 44%.…”

mentioning

confidence: 99%

Improving Practice

Jacobson¹,

Tescher²,

Miers³

et al. 2008

Journal of Nursing Care Quality

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Cervical collars are necessary to stabilize the cervical spine of trauma patients but are known to contribute to the development of occipital pressure ulcers. A quality improvement project that began on one nursing unit stimulated the development of evidence-based practice guidelines and a multidisciplinary research study. As a result, a standardized plan of care and cervical collar recommendations were implemented, resulting in a sharp decline in the incidence of occipital pressure ulcers.

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Úlceras por presión secundarias a la inmovilización con collarín cervical: una complicación de la lesión cervical aguda

Cited by 11 publications

References 40 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

Cervical spine injuries and collar complications in severely injured paediatric trauma patients

Improving Practice

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