Research
Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP.
*Department of Neurosurgery, Institute of Neurological Sciences, The Prince of Wales Hospital, +School of Surgery, University of New South Wales, Sydney, New South Wales and -Department of Neurosurgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
Summary
BACKGROUND
Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP.
METHODS
A prospective series of 10 head-injured patients with a postresuscitation Glasgow coma scale score of nine or less had
ICP measurements before and after cervical hard collar application.
RESULTS
Nine out of 10 patients had a rise in ICP following application of the collar. The difference in pre- and postapplication ICP was statistically significant (P < 0.05).
CONCLUSIONS
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.
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Keywords
cervical spine injury, hard collar, head injury, intracranial pressure
Abbreviations
CT, computed tomography; ICP, intracranial pressure; MRI, magnetic resonance imaging.
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