Effect of cervical hard collar on intracranial pressure after head injury

Mobbs, Ralph J.; Stoodley, Marcus A.; Fuller, John

doi:10.1046/j.1445-2197.2002.02462.x

Cited by 135 publications

(106 citation statements)

References 8 publications

(8 reference statements)

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“…However, cervical spine immobilization also has its disadvantages, including patient discomfort, respiratory compromise due to strapping techniques, skin ulcerations, dysphagia, as well as cost of equipment and training of relevant personnel (16). It has also been suggested that cervical hard collars significantly increase intracranial pressure after head injury (17). Therefore, it is in the patient's best interests for spinal immobilization to be delivered appropriately and optimally.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine immobilization in the elderly population

Rao

Phan²,

Mobbs

et al. 2016

J. Spine Surg.

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Background: Immobilization of the cervical spine is a cornerstone of spinal injury management. In the context of suspected cervical spine injury, patients are immobilized in a 'neutral position' based on the head and trunk resting on a flat surface. It is hypothesized that the increased thoracic kyphosis and loss of cervical lordosis seen in elderly patients may require alternative cervical immobilization, compared with the 'neutral position'.Methods: To investigate this, an audit of pan-scan CT performed on consecutive major trauma patients aged over 65 years was carried out over a 6-month period. Utilizing the pan-CT's localizing scout film, a novel measurement, the 'chin-brow horizontal' angle was independently measured by a senior spine surgeon (RJM) and a neurosurgeon (PJR) with the gantry used as a horizontal zero-degree reference. The benefit of the 'chin-brow horizontal' angle in the trauma setting is it can be assessed from the bedside whilst the patient is immobilized against a flat surface.Results: During the 6-month study period, 58 patients were identified (30 male, 28 female), with an average age of 77.6 years (minimum 65, maximum 97). Results showed that 'chin-brow horizontal' angles varied widely, between +15.8 degrees in flexion to −30.5 degrees in extension (mean −12.4 degrees in extension, standard deviation 9.31 degrees. The interobserver correlation was 0.997 (95% CI: 0.995-0.998).Conclusions: These findings suggest that, due to degenerative changes commonly seen in elderly patients, the routine use of the 'neutral position' adopted for cervical spine immobilization may not be appropriate in this population. We suggest that consideration be taken in cervical spine immobilization, with patients assessed on an individual basis including the fracture morphology, to minimize the risk of fracture displacement and worsened neurological deficit.

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Section: Discussionmentioning

confidence: 99%

Cervical spine immobilization in the elderly population

Rao

Phan²,

Mobbs

et al. 2016

J. Spine Surg.

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“… Encouraging selective immobilisation rather than a blanket policy. [11][12][13] The articles identified with contrary conclusions to the Consensus guidelines were found to have been of low quality, containing substantial levels of bias, inconsistencies in the methodology and missing data.…”

Section: Consensus Guidelinesmentioning

confidence: 99%

“…[12]  Longer hospital stays, increased radiographs and subsequent increase in cost and exposure to hospital acquired infections and radiation.…”

Section: Side Effectsmentioning

confidence: 99%

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The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

Purvis

Carlin

Driscoll

2017

The American Journal of Emergency Medicine

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Intro:The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines. This critical review aims to determine the validity of current recommendations by balancing the potential benefits and side effects of phSI. Method.A review of the literature was carried out by two independent assessors using Medline, PubMed, EMBASE and the Cochrane Library databases. Manual searches of related journals and reference lists were also completed. The selected body of evidence was subsequently appraised using a checklist derived from SIGN and CASP guidelines, as well as Crombie's guide to critical appraisal.

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“…Manual inline immobilisation by the fi rst aider may be used rather than a cervical collar. The application of cervical collars by fi rst aid providers is discouraged, as the current literature shows more potential harm than benefi t. (83)(84)(85)(86)(87)(88)(89) Furthermore, it requires extensive training for proper application. (g) Fractures and dislocations: When a fracture or dislocation is suspected, the fi rst aid provider should not move or try to straighten the injured extremity.…”

Section: Medicalmentioning

confidence: 99%

Guidelines for Bystander First Aid 2016

Pek¹

2017

smedj

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Cardiac life support is a form of fi rst aid for cardiac emergencies. However, research and evidence in this fi eld is lacking compared with other forms of fi rst aid. Having identifi ed the common emergencies that are encountered in the hospital, based on the available evidence, we have put together what could be an evidence-based approach to the fi rst aid management of some of these common emergencies, viz. breathlessness, chest pain, allergies, stroke, heat injury, poisoning, unconsciousness, seizures, and trauma situations such as bleeding, wounds, contusions, head injury, burns and fractures. Educating the public is the key to developing a fi rst responder bystander. These guidelines could become the basis for training of the public.

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Effect of cervical hard collar on intracranial pressure after head injury

Abstract: Early assessment of the cervical spine in head-injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.

Cited by 135 publications

References 8 publications

Cervical spine immobilization in the elderly population

Cervical spine immobilization in the elderly population

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

Guidelines for Bystander First Aid 2016

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