title: Factors predicting cervical collar-related decubitus ulceration in major trauma patients.
abstract: METHODS
  Retrospective medical record and electronic database audit to ascertain the incidence and predictors of cervical collar-related decubitus ulceration (CRU).
  
  
  OBJECTIVE
  To determine the incidence and risk factors associated with the development of CRU in major trauma patients immobilized in Philadelphia cervical collars.
  
  
  BACKGROUND
  Cervical spine immobilization requires the utilization of a cervical collar before spinal clearance, which may be complicated by CRU and increased morbidity.
  
  
  METHODS
  From a trauma registry database at a level 1 trauma center, 299 major trauma patients admitted over a 6-month period were identified. Predictors of CRU were retrospectively examined and assessed for relative importance using medical records and prospective infection control and radiology databases.
  
  
  RESULTS
  Clinically significant predictors of CRU were ICU admission (P = 0.007), mechanical ventilation (P = 0.005), the necessity for cervical MRI (P < or = 0.001), and time to cervical spine clearance (P < or = 0.001). Time to cervical spine clearance was the major indicator, such that the risk of CRU increased by 66% for every 1 day increase in cervical collar time.
  
  
  CONCLUSIONS
  In major trauma patients at a level 1 trauma center, the risk of CRU development increased significantly for every day of Philadelphia cervical collar time. Associated increased morbidity may be reduced by measures aimed at earlier cervical spine clearance.
authors.affiliation: National Trauma Research Institute, Alfred Hospital, Melbourne, Australia. h.ackland@alfred.org.au
authors.forename: Helen M
authors.initials: HM
authors.lastname: Ackland
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: James D
authors.initials: JD
authors.lastname: Cooper
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.forename: Thomas
authors.initials: T
authors.lastname: Kossmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000009:adverse effects*; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology*; D012149:Restraint, Physical / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000473:pathology* / Q000628:therapy