Abstract
Purpose: Although the use of a cervical collar in the prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on raising intracranial pressure (ICP) in traumatic brain injury (TBI) patients. In the absence of studies measuring ICP in the prehospital setting, the aim of this study was to systematically review the data related to ICP changes measured after presentation at the hospital in patients who had arrived wearing cervical collars. Methods: We searched Medline (PubMed), Embase, CINAHL, and Google Scholar for studies that investigated in-hospital ICP changes in TBI patients arriving at the hospital wearing collars. Titles, abstracts, and full texts were then searched for inclusion in the study. A narrative synthesis, as well as a meta-analysis, was performed. Results: Of the 1006 studies identified, only three met the inclusion/exclusion criteria. The quality of the three included studies was moderate and the risk of bias was low. All three studies used the Laerdal Stifneck collar, but all studies showed an increase in ICP after application of the collar. A further three studies that measured ICP but did not fit the systematic search were also included due to low patient numbers. A meta-analysis of the pooled data confirmed a significant increase in ICP, although between the four studies, only 77 patients were included. The meta-analysis also confirmed that after removal of the collar, there was a significant decrease in ICP. Conclusions: Our study suggests that the use of a cervical collar increases ICP in TBI and head injury patients, which may have detrimental effects. However, due to the extremely low sample size from all six studies, caution must be exercised when interpreting these data. Thus, further high-quality research is necessary to unequivocally clarify whether cervical collars should be used in patients with TBI.
Highlights
Traumatic brain injury (TBI) is an increasing public health issue and contributes to trauma-associated injuries globally [1]
Studies have highlighted the negative outcome of TBI such as disability and memory impairments, which worsen with more severe TBI
Trauma programmes have highlighted that adequate prehospital management has successfully led to a decline in morbidity and mortality from TBI [4]
Summary
Traumatic brain injury (TBI) is an increasing public health issue and contributes to trauma-associated injuries globally [1]. The most common causes of TBI are falls and road traffic accidents, which account for >50% of the total number of cases [2]. According to the World Health Organization, TBI is the leading cause of nearly half of all disabilities. The 2010 Global Burden of Disease project estimated that the annual global prevalence of TBI is approximately 15 million [3]. The incidence of TBI that results in hospital admission is estimated to be 262 cases per 100,000 individuals, in an evaluation of 16 European countries. In the United States, >1 million people incur TBIs, the prevalence of which is higher in males than in females. Trauma programmes have highlighted that adequate prehospital management has successfully led to a decline in morbidity and mortality from TBI [4]
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