Effect of cervical hard collar on intracranial pressure after head injury.
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.
Mobbs
Ralph J
RJ
Department of Neurosurgery, Institute of Neurological Sciences, The Prince of Wales Hospital, Sydney, New South Wales, Australia. ralphmobbs@hotmail.com
Stoodley
Marcus A
MA
Fuller
John
J
D000293:Adolescent; D000328:Adult; D001915:Braces; D006259:Craniocerebral Trauma / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D009333:Neck; D011446:Prospective Studies