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Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort.

Karason S, Reynisson K, Sigvaldason K, Sigurdsson GH - Scand J Trauma Resusc Emerg Med (2014)

Bottom Line: The mean neck movement (53 ± 9°) decreased significantly with all the collars (p < 0.001) from 18 ± 7° to 25 ± 9° (SN < MJ < PH < VI).Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on JVP.The methodology used in this study may offer a new approach to evaluate clinical efficacy and safety of neck collars and aid their continued development.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland. skarason@landspitali.is.

ABSTRACT

Background: Concern has been raised that cervical collars may increase intracranial pressure in traumatic brain injury. The purpose of this study was to compare four types of cervical collars regarding efficacy of immobilizing the neck, effect on jugular venous pressure (JVP), as a surrogate for possible effect on intracranial pressure, and patient comfort in healthy volunteers.

Methods: The characteristics of four widely used cervical collars (Laerdal Stifneck(®) (SN), Vista(®) (VI), Miami J Advanced(®) (MJ), Philadelphia(®) (PH)) were studied in ten volunteers. Neck movement was measured with goniometry, JVP was measured directly through an endovascular catheter and participants graded the collars according to comfort on a scale 1-5.

Results: The mean age of participants was 27 ± 5 yr and BMI 26 ± 5. The mean neck movement (53 ± 9°) decreased significantly with all the collars (p < 0.001) from 18 ± 7° to 25 ± 9° (SN < MJ < PH < VI). There was a significant increase in mean JVP (9.4 ± 1.4 mmHg) with three of the collars, but not with SN, from 10.5 ± 2.1 mmHg to 16.3 ± 3.3 mmHg (SN < MJ < VI < PH). The grade of comfort between collars varied from 4.2 ± 0.8 to 2.2 ± 0.8 (VI > MJ > SN > PH).

Conclusion: Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on JVP. Vista and Miami J were the most comfortable ones. The methodology used in this study may offer a new approach to evaluate clinical efficacy and safety of neck collars and aid their continued development.

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Summary of results. Collars in order of decreasing immobilization, increasing effect on jugular venous pressure and decreasing comfort. Tables 1, 2 and 3 show where there was a significant difference between the collars, compared to baseline and each other. However, in this figure a double-headed arrow is used to show where there was not a significant difference between entities. The Stifneck collar seems to suit well in emergency circumstances (greatest immobilization, least effect on jugular venous pressure, but third regarding comfort, so it should probably not be used for long-term treatment). The Miami J collar seems to be a good all-round collar for both emergency and long-term treatment (second in all parameters without differing significantly from those in the first place). The Vista collar seems more suited for long-term treatment (first place regarding comfort, third regarding effect on jugular venous pressure but forth concerning immobilization). The Philadelphia collar seems only suited for short-term treatment (highest effect on jugular venous pressures, third concerning immobilization and fourth place regarding comfort).
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Figure 3: Summary of results. Collars in order of decreasing immobilization, increasing effect on jugular venous pressure and decreasing comfort. Tables 1, 2 and 3 show where there was a significant difference between the collars, compared to baseline and each other. However, in this figure a double-headed arrow is used to show where there was not a significant difference between entities. The Stifneck collar seems to suit well in emergency circumstances (greatest immobilization, least effect on jugular venous pressure, but third regarding comfort, so it should probably not be used for long-term treatment). The Miami J collar seems to be a good all-round collar for both emergency and long-term treatment (second in all parameters without differing significantly from those in the first place). The Vista collar seems more suited for long-term treatment (first place regarding comfort, third regarding effect on jugular venous pressure but forth concerning immobilization). The Philadelphia collar seems only suited for short-term treatment (highest effect on jugular venous pressures, third concerning immobilization and fourth place regarding comfort).

Mentions: The degree of neck movement was significantly reduced from baseline with all the four collars, but to a various degree, as movement decreased from 53° to between 18° and 25° (Figure 3). It is difficult to compare these results with other studies as different methods are used to measure immobilization and present outcomes. However, the total angular displacement for Stifneck was reported to be 17.55 ± 8.9° in one study [19], which is very similar to our results of 18 ± 7°, indicating a reliable setup of measurements. It is intricate to judge the clinical importance of the extent of immobilization in patients with an unstable cervical spine injury. Also, for simplicity of presentation we present only average movement for all directions which might devalue important differences between devices, but our main interest was to study the effect on jugular venous pressure. There are several other studies that have compared the relative effectiveness of preventing spinal motion of various types of neck collars [6-10].


Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort.

Karason S, Reynisson K, Sigvaldason K, Sigurdsson GH - Scand J Trauma Resusc Emerg Med (2014)

Summary of results. Collars in order of decreasing immobilization, increasing effect on jugular venous pressure and decreasing comfort. Tables 1, 2 and 3 show where there was a significant difference between the collars, compared to baseline and each other. However, in this figure a double-headed arrow is used to show where there was not a significant difference between entities. The Stifneck collar seems to suit well in emergency circumstances (greatest immobilization, least effect on jugular venous pressure, but third regarding comfort, so it should probably not be used for long-term treatment). The Miami J collar seems to be a good all-round collar for both emergency and long-term treatment (second in all parameters without differing significantly from those in the first place). The Vista collar seems more suited for long-term treatment (first place regarding comfort, third regarding effect on jugular venous pressure but forth concerning immobilization). The Philadelphia collar seems only suited for short-term treatment (highest effect on jugular venous pressures, third concerning immobilization and fourth place regarding comfort).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4066830&req=5

Figure 3: Summary of results. Collars in order of decreasing immobilization, increasing effect on jugular venous pressure and decreasing comfort. Tables 1, 2 and 3 show where there was a significant difference between the collars, compared to baseline and each other. However, in this figure a double-headed arrow is used to show where there was not a significant difference between entities. The Stifneck collar seems to suit well in emergency circumstances (greatest immobilization, least effect on jugular venous pressure, but third regarding comfort, so it should probably not be used for long-term treatment). The Miami J collar seems to be a good all-round collar for both emergency and long-term treatment (second in all parameters without differing significantly from those in the first place). The Vista collar seems more suited for long-term treatment (first place regarding comfort, third regarding effect on jugular venous pressure but forth concerning immobilization). The Philadelphia collar seems only suited for short-term treatment (highest effect on jugular venous pressures, third concerning immobilization and fourth place regarding comfort).
Mentions: The degree of neck movement was significantly reduced from baseline with all the four collars, but to a various degree, as movement decreased from 53° to between 18° and 25° (Figure 3). It is difficult to compare these results with other studies as different methods are used to measure immobilization and present outcomes. However, the total angular displacement for Stifneck was reported to be 17.55 ± 8.9° in one study [19], which is very similar to our results of 18 ± 7°, indicating a reliable setup of measurements. It is intricate to judge the clinical importance of the extent of immobilization in patients with an unstable cervical spine injury. Also, for simplicity of presentation we present only average movement for all directions which might devalue important differences between devices, but our main interest was to study the effect on jugular venous pressure. There are several other studies that have compared the relative effectiveness of preventing spinal motion of various types of neck collars [6-10].

Bottom Line: The mean neck movement (53 ± 9°) decreased significantly with all the collars (p < 0.001) from 18 ± 7° to 25 ± 9° (SN < MJ < PH < VI).Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on JVP.The methodology used in this study may offer a new approach to evaluate clinical efficacy and safety of neck collars and aid their continued development.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland. skarason@landspitali.is.

ABSTRACT

Background: Concern has been raised that cervical collars may increase intracranial pressure in traumatic brain injury. The purpose of this study was to compare four types of cervical collars regarding efficacy of immobilizing the neck, effect on jugular venous pressure (JVP), as a surrogate for possible effect on intracranial pressure, and patient comfort in healthy volunteers.

Methods: The characteristics of four widely used cervical collars (Laerdal Stifneck(®) (SN), Vista(®) (VI), Miami J Advanced(®) (MJ), Philadelphia(®) (PH)) were studied in ten volunteers. Neck movement was measured with goniometry, JVP was measured directly through an endovascular catheter and participants graded the collars according to comfort on a scale 1-5.

Results: The mean age of participants was 27 ± 5 yr and BMI 26 ± 5. The mean neck movement (53 ± 9°) decreased significantly with all the collars (p < 0.001) from 18 ± 7° to 25 ± 9° (SN < MJ < PH < VI). There was a significant increase in mean JVP (9.4 ± 1.4 mmHg) with three of the collars, but not with SN, from 10.5 ± 2.1 mmHg to 16.3 ± 3.3 mmHg (SN < MJ < VI < PH). The grade of comfort between collars varied from 4.2 ± 0.8 to 2.2 ± 0.8 (VI > MJ > SN > PH).

Conclusion: Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on JVP. Vista and Miami J were the most comfortable ones. The methodology used in this study may offer a new approach to evaluate clinical efficacy and safety of neck collars and aid their continued development.

Show MeSH
Related in: MedlinePlus