AN EVALUATION OF THE EFFECTS OF SEMIRIGID CERVICAL COLLARS IN PATIENTS WITH SEVERE CLOSED-HEAD INJURY

The use of a semirigid cervical collar has been recommended to prevent further cervical spine injury in the management of trauma patients. T hese cervical collars are kept on obtunded patients for prolonged peri ods. We assessed the incidence of cervical collar related decubiti in patients with severe closed head injury (SCHI). We also assessed the u tility of fluoroscopy in clearing the cervical spine of patients with SCHI, A retrospective chart review was performed on 52 consecutive pat ients with SCHI at a community hospital-based Level II trauma center o ver an 8-month period. Thirteen of 34 patients (38%) who survived >24 hours after admission developed decubiti related to the cervical colla r. The patients who developed decubiti had a significantly greater dur ation of cervical collar placement (21.15 +/- 0.99 days) as compared w ith patients who did not develop decubiti (4.42 +/- 0.79 days; P = 0,0 01). Eight patients had their cervical spine assessed for ligamentous injury by bedside fluoroscopy. All eight patients had early collar rem oval; none of these patients developed decubiti, Patients with SCHI wi th semirigid cervical collars kept in place for prolonged periods of t ime are at risk for developing decubiti. Fluoroscopy in addition to st andard radiographs may ''clear'' the cervical spine and allow early re moval of these collars.