Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies
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Spinal cord injury (SCI) is present in around 2–4% of trauma victims. More than half of this injuries are located at the cervical region. Twenty percent of victims with cervical spinal trauma and 5% of patients with severe traumatic brain injury (TBI) will have an SCI. Cervical immobilization with rigid or semirigid collars is routinely used as prophylactic or definitive treatment intervention in general trauma care. An important adverse effect of cervical collars application is the increase in intracranial pressure (ICP) values. This systematic review and meta-analysis aim to estimate the overall magnitude of ICP changes after cervical collar application.
Major electronic databases (Ovid/Medline, Embase and Cochrane Library) were systematically searched for prospective studies that assessed ICP changes after cervical collar applications. Study level characteristics and ICP values before, during and after cervical collar application, were extracted. The meta-analysis was performed using random-effects model.
Five studies comprising 86 patients were included in the systematic review and the quantitative synthesis. The overall increase in ICP after collar application was statistically significant (weighted mean difference [WMD] = 4.43; 95%CI 1.70, 7.17; P < 0.01), meaning an overall ICP increase of approximately 4.4 mmHg. The decrease in ICP values after collar removal reached statistical significance (WMD = − 2.99; 95%CI − 5.45, − 0.52; P = 0.02), meaning an overall ICP decrease of approximately 3 mmHg after collar removal. ICP values before and after cervical collar application were not statistically significant (WMD = 0.49; 95%CI − 1.61, 2.59; P = 0.65), meaning no ICP change.
Heterogeneous studies of application of cervical collars as a partial motion restriction strategy after injuries have demonstrated increases in ICP in TBI patients. Increases in ICP can induce complications in TBI patients. Appropriate selection criteria for cervical motion restriction in TBI patients need to be considered.
KeywordsCervical collar Intracranial pressure Intracranial hypertension Traumatic brain injury Meta-analysis
Spinal cord injury
Traumatic brain injury
Glasgow coma scale
Weighted mean difference
- 95% CI
95% confidence interval
RANP was contributed with the design of the study, the literature search, data acquisition, data analysis, statistical analyses, manuscript editing, manuscript preparation, manuscript review and submitted the article to the journal. AR was contributed with data analysis, manuscript editing and manuscript preparation. DAG was contributed with design of the study, definition of intellectual content, the literature search, data acquisition, data analysis, manuscript editing and manuscript preparation.
Source of support
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval/Informed Consent
This article does not contain any studies with human participants or animals performed by any of the authors.
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