Introduction
Aim
Methods
Data sources and search strategy
Inclusion and exclusion criteria
Study selection
Quality assessment
Reference | Country | Article type & subjects | Observations | Key findings | Weaknesses |
---|---|---|---|---|---|
Measurements | |||||
Jacobsen et al., 2008 [5] | USA | Literature review | Reduction in occipital pressure ulcers | Improved nursing education and a variety of collars caused an reduction in occipital ulcer incidence | Only looked at their own trauma centre |
Liew et al., 1994 [13] | Australia | Case review: 2 patients | Pressure ulcer development | Ulceration is a complication of hard collar use | Only looked at 2 patients |
Murphy et al., 1997 [14] | USA | Case review: 1 patient | Pressure ulcer development | Occipital pressure ulcers after collar use are common; improved wound care/more suitable collars advised | Only one patient reviewed |
Walker, 2012 [4] | UK | Retrospective analysis: | Pressure ulcer development | Cervically immobilised patients have an increased risk of developing pressure ulcers | Looked at all types of immobilisation not just semi-rigid collars |
90 patients | |||||
Powers, 1997 [20] | USA | Retrospective analysis | Pressure ulcer development | Improved education, more suitable collars plus early collar removal protocol resulted in a ulcer reduction | Only looked at their own trauma centre |
Blaylock, 1996 [19] | USA | Retrospective analysis and study: 20 patients | Pressure ulcer development | Improved education on skin condition/wound care and collar fitting, plus a new collar design resulted in no ulcers in the subjects. | Possibility that the team were conscious regarding ulcer development. Small sample size and only one trauma centre included |
Molano et al., 2004 [15] | Spain | Retrospective study: | Pressure ulcer development | 23.9% had ulcers; with occipital ulcers being more problematic to treat | Only looked at their own unit |
92 patients | |||||
Chendrasekhar et al., 1998 [21] | USA | Retrospective study: | Pressure ulcer development | Ulceration is related to duration of collar wear; early collar removal advocated | Only 34 patients actually included due to mortality and only 8 had their collar removed earlier than normal |
52 patients | |||||
Beavis, 1989 [17] | UK | Study: 10 volunteers, | Tissue Interface Pressure at chin and occiput | Passive and active results showed wide variance, but Beavis felt that the pressure was a positive feature, being an incentive not to move | No consideration for the impact of high interface pressure |
4 collars | |||||
(25-172 mmHg) | |||||
Black et al., 1998 [22] | USA | Study: 20 volunteers, | Tissue Interface Pressure at occiput (39-83 mmHg) plus skin temperature and humidity | No difference between the interface pressures of the collars was found; felt skin humidity was an important factor in ulcer development | Collars were worn for up to 30 minutes possibly impacting on pressure readings due to foam compression within the collar |
2 collars | |||||
Ferguson et al., 1993 [10] | UK | Study: 5 patients, | Tissue Interface Pressure around neck area (1.2-11.8 mmHg) | Pressures recorded depended on the tightness of the collar | Sensor positions were possibly not indicative of true pressure points; tensions applied were subjective |
6 collars | |||||
Fisher, 1978 [16] | USA | Study: 8 patients, | Tissue Interface Pressure at chin an d occiput | Passive interface pressures varied with collar tightness: | Used the same person to apply the collar; ‘tightness’ was subjective |
1 collar | |||||
(25-105 mmHg) | |||||
Plaisier et al., 1994 [18] | USA | Study: 20 volunteers, | Tissue Interface Pressure at chin, occiput and mandible (27-57 mmHg); plus comfort | Philadelphia/Stifneck collars exceed capillary closing pressure in some positions, yet Newport/Miami J did not; comfort ratings tallied with this | Skin humidity temperature data would have confirmed their ‘skin friendly’ endorsement of the Newport and Miami J collar |
4 collars | |||||
Tescher et al., 2007 [23] | USA | Study: 48 patients, | Tissue Interface Pressure at occiput and mandible | Miami J/Miami J with Occian back had lower pressures recorded both seated and supine; however all maximal pressures recorded exceeded capillary closing pressure | Admit that interface pressure is an important consideration in ulcer development but admit other factors may play an important part |
4 collars |
Reference | Country | Article type & subjects | Observations | Key findings | Weaknesses |
---|---|---|---|---|---|
Measurements | |||||
Craig et al., 1991 [25] | UK | Case review: | Intracranial pressure and collar use | Collar use was associated with impaired venous drainage and as such relates to an increase in ICP | Only two patients |
2 patients | |||||
Lemyze et al., 2011 [28] | France | Case review: | Level of consciousness | Collar use post hanging may exacerbate cerebral oedema due to compression of neck veins | Only one patient |
1 patient | |||||
Dunham et al., 2008 [32] | USA | Literature Review | Risks with MRI and collar use | Collar use is associated with a rise in ICP, and secondary brain injury; early collar removal advocated | Evidence supports the theory but no substantial proof |
Ho et al., 2002 [7] | China | Literature Review | Intracranial pressure and collar use | Collars appear to act like a tourniquet around the neck, potentially exacerbating a head injury and increasing ICP | Evidence supports the theory but no substantial proof |
Dunham et al., 2011 [8] | USA | Simulation study | Collar use and outcome | Early collar removal is advocated for unstable/high risk and stable patients with spinal injuries | Simulation study only; no real proof for claims |
Davies et al., 1996 [6] | UK | Study: | ICP before and after collar application | Stifneck collar may cause a rise in intracranial pressure. | Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined |
19 patients | |||||
Hunt et al., 2001 [29] | UK | Study: | ICP before and after collar application | Collars are associated with a rise in intracranial pressure, potentially worse if the ICP is higher to start with | Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined |
30 patients | |||||
Kolb et al., 1999 [24] | USA | Study: | Cerebrospinal fluid pressure before and after collar application | Cerebrospinal fluid pressure increased after collar application, but no clear associated with BMI | Collars were placed when the patient was inclined to the side rather than supine; exact mechanism for rise in ICP was not determined |
20 patients | |||||
Kuhnigk et al., 1993 [30] | Germany | Study: | Intracranial pressure and collar use | Found no correlation between collar use and increased intracranial pressure | Baseline ICP readings were higher than in other reports and as such may have had an impact on the results |
18 patients | |||||
Mobbs et al., 2002 [9] | Australia | Study: | ICP before and after collar application | Intracranial pressure was higher following the application of a collar | Supports hypothesis for collars affecting ICP but exact mechanism for rise in ICP was not determined |
10 patients | |||||
Stone et al., 2010 [31] | USA | Study: | Jugular vein dimensions before and after collar application | Collar application associated with alteration to jugular vein diameter indicative of venous obstruction | Supports hypothesis for collars affecting ICP but no mechanism was determined as actual ICP was not measured |
42 volunteers | |||||
Porter et al., 1999 [27] | UK | Study: | ICP before and after collar application | All patients showed a rise in ICP following collar application | Supports hypothesis for collars affecting ICP but no mechanism was determined |
9 patients | |||||
Ferguson et al., 1993 [10] | UK | Study: | Tissue Interface Pressure around neck area | Normal jugular venous pressure when supine was 2-7 mmHg, concluded pressures exerted on the neck over this will cause a ‘back pressure’ | Supposition rather than fact with the relationship of collar use to increased ICP |
5 patients | |||||
Raphael et al., 1994 [26] | UK | Study: | Cerebrospinal fluid pressure before and after collar application | 7/9 experienced raised cerebrospinal fluid pressure following collar application | Supports hypothesis for collars affecting ICP but no mechanism was determined |
9 patients |