The effect of a rigid collar on intracranial pressure

Davies, Gareth E.; Deakin, Charles D.; Wilson, A.

doi:10.1016/s0020-1383(96)00115-5

Cited by 178 publications

(128 citation statements)

References 14 publications

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“…Studies that have examined this possibility have not found a causal relationship; there were no associated changes in mean arterial blood pressure or heart rate after collar application, and the elevation of ICP was also found in well-sedated patients in whom a nociceptive response would not be expected. [3][4][5] Another explanation for the elevation of ICP seen with cervical collars is that the collars disrupt venous outflow. Intracranial venous drainage may be hindered by an increase in internal jugular pressure due to the collar's direct compression of the jugular veins or by some other mechanism.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Rigid Cervical Collars on Internal Jugular Vein Dimensions

Stone

Tubridy

Curran

2010

Academic Emergency Medicine

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Objectives: Prior research has demonstrated that rigid cervical collars cause an increase in intracranial pressure (ICP). The mechanism for this effect is unclear and one proposed mechanism involves obstruction of venous outflow in the neck. Ultrasound (US) allows assessment of internal jugular vein dimensions and may yield information regarding the mechanism for the increase in ICP seen with rigid collar application.Methods: Forty-two healthy volunteers underwent US examination of the internal jugular vein before and after cervical collar application. Internal jugular vein cross-sectional areas were compared with and without the cervical collar in place. Results:The cross-sectional area of the internal jugular vein increased significantly (p < 0.0001) after application of the cervical collar. The mean percentage increase in cross-sectional area was 37% (95% confidence interval [CI] = 20% to 53%).Conclusions: Internal jugular vein cross-sectional area increases after application of a rigid cervical collar. This supports the hypothesis that venous obstruction in the neck may contribute to the increase in ICP seen after rigid collar application.

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Section: Discussionmentioning

confidence: 99%

“…1,2 Recent studies have suggested a potential detrimental effect of cervical collars on patients with severe head injury by demonstrating that cervical collars can elevate intracranial pressure (ICP). [3][4][5][6][7][8] Increased ICP decreases cerebral perfusion and exacerbates ischemia, thus increasing the likelihood of secondary brain injury.…”

mentioning

confidence: 99%

The Effect of Rigid Cervical Collars on Internal Jugular Vein Dimensions

Stone

Tubridy

Curran

2010

Academic Emergency Medicine

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“…• Increased intracranial pressure [42][43][44][45] worsens the outcome of a population with co-existing head injury in up to one-third of cases [19].…”

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confidence: 99%

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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“…Darüber hinaus sind klinisch relevante Komplikationen beschrieben worden, wie z. B. ein erhöhter intrakranieller Druck nach der Anlage eines Halskragens [893][894][895][896][897]. Das routinemä-ßige Anlegen durch Ersthelfer wird nicht empfohlen.…”

Section: Einschränkung Der Halswirbelsäulenbeweglichkeitunclassified